Billing and Collections Specialist

Role Overview

• Manage billing within the practice management system, focusing on working draft invoices and resolving rejections.
• Perform final reviews for duplicate claims and manage the accurate export of billing data.
• Handle Remote Patient Monitoring (RPM) submissions to ensure timely reimbursement.
• Review billing data for completeness and accuracy and ensure all provider notes are signed.
• Call insurance companies to verify eligibility and benefits for new leads, utilizing portals such as OneSource and Availity.
• Activate new accounts in the patient account management system for membership switches.
• Review and collect patient balances in the practice management system.
• Identify cases requiring authorization, compile medical records, and submit requests via portal or fax.
• Process payments and refunds and inform patients of overdue balances.
• Focus on account escalations, working large balances, and clearing payer blockers to ensure consistent cash flow.
• Review and complete auto-posted payments in the practice management system, ensuring SFTP remit files and EOBs are properly reconciled daily.

Requirements

• High school diploma or GED required; Associate or Bachelor’s degree in Healthcare Administration, Finance, or a related field preferred.
• Proven experience in Revenue Cycle Management (RCM), patient collections, or medical billing/coding, preferably supporting a specialized healthcare program.
• Skilled in using an Electronic Medical Record (EMR), practice management system, payer portals, and a comprehensive understanding of insurance verification and eligibility.
• Strong ability to perform root-cause analysis on denials and resolve complex billing discrepancies.
• Excellent professional communication skills for frequent interaction with insurance companies, patients, and internal provider teams.
• High level of professionalism, patience, and empathy when working with patients on sensitive financial issues.
• Ability to support occasional weekend coding tasks or approved overtime to meet critical submission deadlines.