Billing Specialist II

This in on-site role 

Job Summary

The Billing Specialist II plays a key role in ensuring the success of the revenue cycle by managing billing functions, resolving denials, and supporting process improvements. This position serves as a resource for training, special projects, and complex billing issues, with a strong focus on accuracy, compliance, and timely claims resolution.

Key Responsibilities:

Duties include, but are not limited to:

·         Identify, research, and resolve complex claims, including payer-rejected and denied claims.

·         Investigate denial reasons and develop strategies to reduce future occurrences.

·         Prioritize and resolve items in billing and manager hold buckets.

·         Verify insurance coverage and eligibility, update patient records with accurate information.

·         Manage accounts receivable and follow up on outstanding balances.

·         Collaborate with coding, front desk, and clinical teams to ensure claims are accurate and timely.

·         Monitor and report on claim rejection and denial trends; prepare reports from the EHR system as needed.

·         Assist in onboarding and training new billing team members.

·         Support the front desk team with insurance eligibility workflows.

·         Ensure claims are submitted within 2 business days of the date of service.

·         Stay current on payer regulations and industry best practices by attending workshops and training.

·         Manage special projects assigned by leadership to support revenue cycle goals.

·         Provide training to staff on billing processes, payer requirements, and system workflows.

·         Perform other related duties as assigned by supervisors or directors.

Qualifications:

Education:

·         High school diploma or equivalent required.

Experience:

·         Must be (at least) 21 years old.

·         Minimum 5 years’ experience in medical billing, revenue cycle, or related role.

·         Strong knowledge of Medicare and Medicaid billing regulations.

Skills:

·         Minimum 5 years’ experience in medical billing, revenue cycle, or related role.

·         Strong knowledge of Medicare and Medicaid billing regulations.

·         Experience with billing software and EHRs (Athena preferred).

·         Proficiency in Microsoft Office required