Senior Billing Leader

Essential Duties

• Contacts Patients/Caregivers regarding outstanding balances.
• Establishes payment plans to help Patients manage payment of bills.
• Sends delinquent accounts to collection agencies.
• Processes insurance payments to Patient accounts in computerized system.
• Creates and mails insurance claims and Patient statements.
• Rebills insurance companies or other third parties to secure payment for Patients.
• Verifies all entries made by cashiers and makes corrections if necessary.
• Trains appropriate personnel on computerized billing system.
• Responds to Patient billing and statement inquiries.
• Makes recommendations to management for write-offs.

Key Responsibilities

• Claims Processing: Submit, track, and follow up on claims with Medicare, Medicaid, TRICARE, and commercial insurance payers.
• Insurance Verification & Eligibility: Perform benefit validation and coverage checks prior to claim submission.
• Payment Posting & Account Reconciliation: Process payments, contractual adjustments, and maintain accurate account balances.
• Denial Management & Revenue Cycle Support: Identify, analyze, and resolve claim denials, rejections, and underpayments.
• Patient Account Maintenance: Maintain accurate billing records, documentation audits, and account notes.
• Billing Support & Payer Communication: Provide timely assistance for patient and insurance billing inquiries.
• HIPAA Compliance: Maintain patient confidentiality and follow privacy and security regulations.
• Policy Adherence: Follow company procedures, safety guidelines, and infection control standards.
• Team Support: Assist with opening/closing duties and support daily store operations.
• Training & Development: Participate in ongoing training to remain current on products and compliance requirements.
• Time Management: Prioritize tasks to ensure timely service and operational efficiency.

Qualifications

• High school diploma or equivalent.
• Minimum of 2 years of billing experience in the healthcare or DME industry.
• Familiarity with insurance coverage, billing processes, and medical documentation.
• Proven expertise in denial follow-up and resolution, with a results-driven approach.
• Ability to pass a background check and drug screening.
• Strong communication and interpersonal skills.
• Able to work effectively in a team-oriented environment.
• Strong analytical skills, attention to detail, and the ability to prioritize tasks.
• Excellent communication and problem-solving skills.
• Familiarity with ICD-10 coding, HCPCS, and Medicare guidelines.

Preferred

• Previous experience in a DME, medical supply, or healthcare setting.
• Knowledge of DME products and their applications.
• Knowledge of HIPAA guidelines and ability to maintain patient confidentiality.
• Knowledge of claims processing is highly desirable.
• Proficiency in Microsoft Office Suite, particularly Excel.

Position Details

• Competitive compensation structure based on experience.
• Flexibility to work as either a W2 employee or a 1099 contractor.
• Comprehensive benefits package available for W2 employees, including health, dental, and vision insurance.
• Opportunities for professional growth and development.
• A supportive and mission-driven work environment.