Billing Specialist

Aston Carter•Wallingford, CT

3d•Onsite

About The Position

The Billing Specialist / Accounts Receivable Specialist plays a vital role in the hospital’s revenue cycle by managing the full spectrum of billing processes, payment collections, insurance reimbursement, and denial resolution. This position requires a strong understanding of healthcare billing practices, payer requirements, and revenue cycle workflows. The specialist works closely with internal teams to ensure claims are billed correctly, denials are efficiently resolved, and revenue is collected in a timely manner. By supporting process improvement, cross-department communication, and clear patient billing, this role helps ensure the financial health of the organization and a smooth financial experience for patients.

Requirements

Minimum of three (3) years of healthcare billing experience in a hospital patient accounts environment or medical office setting.
Hands-on experience with accounts receivable management in a healthcare setting, including invoicing, reconciliation, and collections.
Strong knowledge of healthcare billing practices, third-party insurance carriers, and payer requirements.
Thorough understanding of standard 835 remittance advice codes, contractual adjustments, and payer payment and reimbursement policies.
Experience with healthcare billing software and billing management systems.
Ability to quickly learn new processes, systems, and payer requirements in a high-volume A/R environment.
Proven ability to work as a self-starter, independently investigate issues, and present solutions.
Strong organizational skills and time management abilities to support multiple vendors and competing priorities.
Excellent analytical skills with the ability to interpret denial trends, payment variances, and A/R aging.
Strong attention to detail and accuracy in data entry and financial reconciliation.
Effective customer service and communication skills for working with patients, payers, and internal teams.
Familiarity with basic medical terminology.
Proficiency with Microsoft Office Suite.

Nice To Haves

High school diploma required.
Associate degree in a business-related field or equivalent from a two-year technical school preferred.
Two or more years of experience in cash posting or revenue cycle operations within a healthcare setting preferred.
Certified Revenue Cycle Representative (CRCR) certification preferred.
Experience with EHR systems such as Meditech, Epic, or Cerner.
Experience with MEDITECH Expanse is highly desirable.
Familiarity with payment portals and ERP systems.
Demonstrated ability to work in a growing healthcare organization and adapt to evolving processes.
Proven ability to contribute to departmental goals, KPIs, and continuous improvement initiatives.

Responsibilities

Ensure claims are accurately submitted to insurance payers in compliance with payer-specific requirements.
Monitor outstanding claims to identify payment issues and take appropriate actions to secure timely resolution and accurate reimbursement from third-party payers or patients.
Analyze denials and underpayments, and initiate appeals or corrected claims as needed.
Track accounts receivable aging, denial trends, and reimbursement effectiveness, and report issues to leadership when necessary.
Ensure accurate billing and timely resolution of issues to support a positive patient financial experience.
Assist patients and internal stakeholders with complex inquiries related to insurance billing and claim status.
Support processes and initiatives that improve the overall patient financial experience.
Evaluate revenue cycle workflows and denial trends to identify opportunities for operational improvement.
Recommend changes to billing and collection practices or systems that enhance claim acceptance and reduce rework.
Assist with testing, implementation, and updates to billing software, EHR systems, and payer portals.
Perform root cause analysis to increase the clean claim rate and reduce first-pass denials.
Contribute to departmental goals, key performance indicators (KPIs), and strategic initiatives to improve revenue cycle performance.
Coordinate with all revenue cycle teams to resolve claim issues and prevent billing errors and denials.
Communicate with payers to verify appropriate payment and resolve discrepancies.
Maintain positive working relationships with internal departments, third-party payers, and patients.
Participate in team meetings and contribute to a culture of continuous improvement, accountability, and collaboration.
Support multiple vendors and accounts simultaneously while maintaining strong time management and organizational practices.
Independently research and resolve complex billing and accounts receivable issues, bringing forward solutions and recommendations.