Regional Billing Specialist
About the role
The Regional Billing Specialist ensures the accuracy, integrity, and efficiency of accounts receivable processes across the designated region. This role serves as a technical expert and oversight mechanism to maximize collections and minimize aging through proactive claims management and adherence to payer regulations.
Responsibilities
Claims Management & Billing Accuracy
- Generate trial claims regularly to identify and resolve billing errors prior to final submission.
- Ensure all prior-month claims are billed immediately following the Triple Check date.
- Maintain a cumulative list of all unbilled claims; provide daily updates and documentation until all prior-month claims are successfully released.
- Review Waystar for rejected claims daily. Ensure all rejections are corrected and resubmitted within one business day.
Payer Compliance & Revenue Integrity
- Maintain comprehensive working knowledge of payer contracts and rules; ensure all billing aligns strictly with specific contract provisions.
- Review Payer Setup Information reports regularly to identify inaccuracies. Execute corrections or direct Business Office Managers to resolve errors via the collection note process.
- Monitor insurance portals for status updates and denials. Execute immediate corrections or submit formal appeals as appropriate to secure payment.
Collections & Cash Application
- Monitor the PointClickCare Upcoming Activity Tab. Review outstanding accounts, initiate new activities, and provide direct feedback/notes to BOMs within the module.
- Ensure detailed, professional notes are added to all accounts worked within PCC to maintain a clear audit trail.
- Post all payer-appropriate cash to PCC daily. Perform regular reconciliations between bank deposits and PCC postings to ensure financial data integrity.
Reporting & Analysis
- Analyze accounts receivable aging reports to identify negative trends or systemic issues.
- Provide concise summaries and actionable insights regarding the region's financial health to executive leadership.
Qualifications
Education and/or Experience:
- 2–4 years of experience in healthcare billing, accounts receivable, or revenue cycle operations.
- Working knowledge of payer rules, billing regulations, and claims submission processes.
- Experience with electronic health record (EHR) and billing platforms (PointClickCare or similar).
- Strong analytical skills with the ability to identify trends, resolve billing issues, and ensure data accuracy.
- Excellent attention to detail, documentation habits, and organizational skills.
- Ability to communicate effectively with Business Office Managers, payers, and cross-functional teams.
Key Competencies
Technical Proficiency:
- Advanced knowledge of PointClickCare and Waystar (or similar clearinghouses).
Physical Demands
- 2–4 years of experience in healthcare billing, accounts receivable, or revenue cycle operations.
- Working knowledge of payer rules, billing regulations, and claims submission processes.
- Experience with electronic health record (EHR) and billing platforms (e.g., PointClickCare, Waystar or similar).
- Strong analytical skills with the ability to identify trends, resolve billing issues, and ensure data accuracy.
- Excellent attention to detail, documentation habits, and organizational skills.
- Ability to communicate effectively with Business Office Managers, payers, and cross-functional teams.
Salary Range
$70,000 - $90,000 annually
Work Environment
The noise level in the work environment is usually low to moderate.
Additional Information
Note: Nothing in this job specification restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons.
Critical Features
- Manage claims and billing processes to ensure accuracy and compliance with payer regulations.
- Collaborate with Business Office Managers and payers to resolve billing discrepancies and improve collections.
- Perform regular reconciliations and trend analysis to maintain financial data integrity.
- Communicate effectively with cross-functional teams to ensure smooth workflow and efficient service delivery.
Join PACS
Elevate Healthcare with Us! PACS is elevating healthcare by revolutionizing our approach to leadership and quality care. Guided by our core values of love, excellence, trust, accountability, mutual respect, and fun, we strive to foster a culture of compassionate care within our teams and the communities we serve. As we grow rapidly, exciting opportunities await you to engage in impactful projects and contribute valuable insights to stakeholders nationwide. If you're ready to make a difference and embrace our mission of creating real change, we invite you to join us at PACS. Together, let’s shape the future of healthcare!
Benefits
Health Coverage:
- Medical, dental, and vision plans to keep you and your family healthy.
PTO and Vacation:
- Benefit from generous paid time off and holidays to relax and recharge.
Financial Wellness:
- Take advantage of Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to manage your healthcare expenses effectively.
Retail Planning:
- Secure your future with our 401(k) plan, complete with company contributions to help you build your retirement savings.
Support When You Need It:
- Employee Assistance Plan (EAP) provides confidential support for personal and professional challenges.