Insurance and Billing Specialist II- Contractual

Towson University•Towson, MD

About The Position

The Insurance and Billing Specialist II performs complex accounting, auditing, billing, and coding procedures within the Revenue Cycle Management unit of the Towson University student health center. The role reviews, leads, and trains staff on proper ICD, CPT, and HCPCS coding to support revenue generation. It carries out billing and insurance procedures for commercial plans, including HMO and PPO plans, and federal-state programs such as Maryland Medicaid. The position verifies insurance coverage; collects, compiles, and submits electronic claims; completes claim forms, follow-ups, payer filings, and appeals; and reviews and reconciles lab invoices, payments, and account balances. It also corrects denials, resolves accounting discrepancies, analyzes financial transactions and bank deposits, and prepares follow-up reports. The specialist uses the electronic health record and third-party billing platforms to maintain patient demographic and insurance eligibility information, complete EFT and ACH transactions, and serve as a staff point person and trainer for billing issues. The role responds to students’ and families’ billing and insurance questions, assists with legal and insurance medical-record responsibilities, and supports Health Center events and outreach programs.

Requirements

High school diploma or GED.
Three years of accounting clerical experience.
General knowledge of bookkeeping principles, mathematical methods and techniques, and accounting standards.
Skill in performing mathematical computations; reviewing and processing financial documents; reconciling financial data; operating calculators, keyboards, manual and automated office equipment, personal computers, and financial software; and inputting data.
Ability to communicate effectively, prepare written records and reports, establish and maintain effective work relationships, and lead and train others in assigned accounting clerical or bookkeeping work.
Ability to perform complex accounting, auditing, billing, and coding procedures within the Revenue Cycle Management unit of the Towson University student health center.
Ability to lead and train other staff in proper ICD, CPT, and HCPCS coding to optimize revenue collection.
Skill in reviewing and processing insurance claims and other financial documents and reconciling financial data.
Knowledge of HMO, MCO, PPO, commercial insurance plans, and Medicaid.
Familiarity with out-of-pocket health care costs, including co-pays, co-insurance, and deductibles.
Knowledge of medical office practices and electronic medical records.
Familiarity with HIPAA and FERPA policies and standards for preventing data breaches involving PHI, PII, and similar information.
Ability to communicate effectively and establish and maintain effective work relationships.
Excellent customer service skills.
Related experience and formal education may substitute for education or experience requirements on a year-for-year basis, except where qualifications are established by law; 30 college credits are equivalent to one year of experience.

Nice To Haves

Certification as a Professional Coder (CPC), Certified Medical Billing Specialist, or Certified Professional Biller.

Responsibilities

Review, lead, and train staff on proper ICD, CPT, and HCPCS coding of visits to support revenue generation.
Carry out insurance and billing procedures for commercial health insurance plans and federal-state programs, including Maryland Medicaid.
Identify and code ledger accounts for out-of-pocket payments and verify insurance coverage.
Collect and compile electronic claims and submit them to insurance companies using the Cognizant-TriZetto and Waystar platforms.
Complete claim forms, payment follow-ups, payer filings, and appeals.
Review, reconcile, and follow up on lab invoices, including Labcorp and Quest Diagnostics.
Reconcile payments and balance bills to appropriate accounts to optimize collections.
Authorize charge tickets and generate payments for patient accounts.
Compile data and generate follow-up reports for the Health Center and insurance companies.
Complete denial corrections and resolve accounting discrepancies.
Analyze financial transactions and bank deposits.
Use the electronic health record to update and retrieve patient demographic and insurance eligibility information from files and databases.
In conjunction with the Insurance and Billing Supervisor, serve as a staff point person and trainer for billing issues within the Point and Click Solutions electronic health record platform.
Use Cognizant-TriZetto and Waystar to complete Electronic Funds Transfer (EFT) and Automated Clearinghouse (ACH) transactions.
Respond to students and families about insurance- and billing-related questions and concerns.
Assist with legal and insurance medical-record responsibilities.
Assist with staffing Health Center events, including student orientations and outreach programs.