Billing Problem Resolution Specialist

United WestLabs • Santa Ana, CA

22h • $24 - $28 • Hybrid

About The Position

The Billing Problem Resolution Specialist is responsible for investigating, resolving, and preventing billing issues related to laboratory testing services. This role serves as a key liaison between patients, clients, health plans, laboratories, providers, and internal departments to ensure accurate billing, timely reimbursement, and exceptional customer service. The specialist analyzes complex billing discrepancies, researches insurance denials, resolves claim issues, and identifies opportunities to improve billing processes and reduce revenue leakage.

Requirements

• High school diploma or equivalent.
• Minimum of two (2) years of experience in healthcare billing, medical claims processing, revenue cycle management, or insurance collections.
• Knowledge of medical terminology, insurance billing processes, and healthcare reimbursement methodologies.
• Experience researching and resolving claim denials and billing discrepancies.
• Strong analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office applications, particularly Excel.
• Ability to prioritize workload, manage multiple cases, and meet deadlines.

Nice To Haves

• Associate's or Bachelor's degree in Healthcare Administration, Business, Finance, or related field.
• Experience with clinical laboratory or diagnostic testing billing.
• Knowledge of CPT, ICD-10, HCPCS, and laboratory coding requirements.
• Experience working with Medicare, Medicaid, commercial insurers, and managed care organizations.
• Familiarity with electronic health records (EHR), laboratory information systems (LIS), and billing software.

Responsibilities

• Investigate and resolve laboratory testing billing discrepancies, claim denials, payment variances, and customer inquiries.
• Research payer policies, coverage determinations, coding requirements, and reimbursement issues affecting laboratory claims.
• Review patient accounts to identify and correct demographic, insurance, coding, or charge-related errors.
• Communicate with insurance carriers, healthcare providers, clients, and patients to obtain information necessary to resolve billing concerns.
• Analyze explanation of benefits (EOBs), remittance advice, denial codes, and payer correspondence.
• Prepare and submit corrected claims, appeals, reconsiderations, and supporting documentation as needed.
• Monitor aging accounts and unresolved billing issues to ensure timely follow-up and resolution.
• Collaborate with laboratory operations, accessioning, client services, compliance, and finance teams to resolve systemic issues.
• Maintain detailed documentation of all account activity and resolution efforts within billing systems.
• Identify recurring billing issues and recommend process improvements to enhance reimbursement and customer satisfaction.
• Assist in the development and maintenance of billing procedures, training materials, and workflow documentation.
• Ensure compliance with federal and state regulations, HIPAA requirements, payer guidelines, and company policies.
• Participate in special projects related to revenue cycle optimization and billing performance improvement.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED