Billing & Claims Specialist

Yeo & Yeo HR Advisory Solutions•Goshen, IN

1d•Onsite

About The Position

Crossroads Health & Cosmetic Center is hiring a Billing and Claims Specialist to manage insurance billing and claims and protect practice revenue. The role includes advocating with payers, reviewing contracts, identifying underpayments, resolving denials, and appealing payer decisions. The position is on-site in Goshen, Indiana initially, with the potential to become remote once appeals follow-up and payment postings are fully digital.

Requirements

Strong medical billing and claims background in a physician or outpatient practice, including some payer dispute or appeals work.
Working knowledge of CPT, ICD-10, HCPCS, E/M office-visit coding, and modifiers 25 and 59.
Experience with commercial denials, corrected claims, and appeals.
Comfort using an EHR or practice management system and payer portals.
Strong follow-through and sound judgment when advocating with payers.
Certification required: CPC or CPB from AAPC, or CCS from AHIMA.

Nice To Haves

CPMA certification from AAPC; the posting notes this is a strong fit for the advocacy portion of the role.
Both CPC and CPB certifications.
Experience with Anthem Indiana, Availity, and Office Ally products, including EHR 24/7, Practice Mate, and Service Center.
Experience in a wellness or HRT practice.
EOS experience.

Responsibilities

Review visit codes against documentation and submit clean claims to commercial payers, including Anthem, Aetna, Cigna, UnitedHealthcare, and UMR.
Work denials, submit corrected claims, and write and pursue appeals.
Review payer contracts, monitor payments against contracted rates, and identify and recover underpayments.
Serve as Crossroads' liaison and advocate with insurers and support contract negotiations.
Research payer and coding changes, maintain current coding guides, and flag issues to the Leadership Team.
Manage the aging report, patient statements, and payment plans.
Answer patient questions about balances, statements, and insurance payments.
Work claims in Office Ally, including Practice Mate, Service Center, and EHR 24/7, and correct rejected claims.
Help transition appeals follow-up and payment posting from paper to electronic systems.
Report weekly Scorecard numbers and raise issues with the Leadership Team.
During the first 90 days, clear or write off backlogged claims before payer filing deadlines, documenting reasons for write-offs.
During the first 90 days, learn Office Ally's Service Center and use its claims tools.
During the first 90 days, confirm how insurance payments arrive and move payers to electronic payments where possible.