Billing Specialist

Job description

(Remote work options available.)

JOB SUMMARY:

The Billing Specialist II is responsible for a broad range of billing functions by providing operational support through the full billing cycle. In this role, the Billing Specialist is responsible to work, research, and resolve billing cycle errors. The mission of the Billing Specialist II is to provide excellent customer service and performs a wide variety of complex billing duties to include vendor management, quality control checks by verifying accuracy and completeness of documentation and prepare claims for billing.

GENERAL REQUIREMENTS:

* Monitor full billing cycle activities and rejections to research and resolve
* Assists with responding to Vendor requests, liaises with relevant stakeholders to respond to questions relating to the requirements and ensures completion of requests to time and quality
* Provide Vendor training, vendor audits, and billing resolution activities
* Perform advanced quality control checks by working rejections, validations, and daily claim edits to investigate questionable data taking necessary actions to resolve and submit claims for completeness and accuracy
* Contributes to the analysis and evaluation of Vendor compliance, performance and risk. Communicates risks and issues to relevant stakeholders and contributes to the development of risk mitigation strategies, recommending corrective and preventive actions to leadership. Ensures key decisions are documented and actions followed up to completion as required
* Engage in regular communication with delegated vendor performance support team to ensure production support activities being supported are in line with service level agreements and business needs
* Play a key role in helping to support vendor partner and lab partner integrations and ongoing relationships
* Establish professional relationships and trusted advisor status with key vendor and lab partners
* Develop a deep understanding of vendor and lab needs/goals and work to ensure the vendors or labs have a shared definition of success
* Serve as the single point of contact for the vendor or lab during an integration implementation and through the lifecycle of the integration / partnership
* Proactively work with the vendor and lab partners and internal stakeholders to understand concerns in the existing partnership and then partner with the product team, engineering team and vendor or lab partner to resolve the issues
* Prepares status and ad-hoc reports
* Identify and resolve issues for all payers (government, commercial, and other third party payers)
* Identifies problems, secures relevant information and identifies possible causes of problems using various systems
* Provide extra resource when needed within the department
* Performing other related duties or special projects as assigned

SKILLS & QUALIFICATIONS:

* Handles multiple tasks simultaneously and works in a production environment.
* Communicates effectively with all levels of staff
* Maintains composure while working under high pressure.
* Demonstrates strong interpersonal skills that foster a positive environment.
* Demonstrates flexibility and ability to adapt to change

EDUCATION/EXPERIENCE REQUIREMENTS

* Ability to work independently to effectively and efficiently perform assigned duties
* Ability to manage multiple priorities and deadlines
* Ability to identify, review, analyze, interpret, and present complex data; and to use creative thinking and logic to investigate and solve problems including making recommendations to outside departments to eliminate future problems.
* Ability to maintain high level of ethics, and a courteous and professional demeanor
* Ability to multi-task, establish and meet deadlines
* Thorough understanding of common healthcare industry terminology, practices and procedures regarding billing and reimbursement
* General PC skills in a MS Windows environment are required. Knowledge and use of MS Office and Billing software required.
* Excellent phone skills are required
* Strong attention to detail and troubleshooting skills are required
* Strong organizational skills with good written and verbal communication
* High School Diploma or equivalent with previous healthcare experience required