Insurance & Billing Specialist

RightSite Health • San Antonio, TX

2d

About The Position

The Insurance and Billing Specialist will be responsible for managing all aspects of the billing cycle, from insurance verification to claim submission and reconciliation. This dynamic role requires a strong understanding of medical billing practices, attention to detail, and the ability to work independently as well as collaboratively with other departments. As a crucial member of our team, you will leverage your expertise to optimize revenue cycles, ensure compliance with industry regulations, and contribute to the financial health of our organization. Your skills in navigating complex insurance systems and resolving billing discrepancies will be instrumental in maintaining smooth operations and enhancing patient satisfaction. If you would like the opportunity to make a tangible impact on community health while working for a dynamic, mission-driven organization, we would love to hear from you!

Requirements

• Bachelor’s degree in healthcare administration, business, or related field or equivalent experience
• Minimum 2 years of experience in medical billing and insurance verification
• Proficiency in medical billing software
• Strong knowledge of CPT and ICD-10 coding
• Familiarity with HIPAA regulations and privacy standards

Nice To Haves

• Comprehensive knowledge of medical billing practices, insurance claim processes, and healthcare reimbursement systems. This includes understanding various coding systems, payer requirements, and regulatory compliance.
• Meticulous focus on accuracy when handling provider information, licensure data, and records. This skill is crucial for minimizing errors in licensure and ensuring proper care given to a provider's personal data.
• Ability to analyze complex licensure issues, identify discrepancies, and develop effective solutions. This competency is essential for resolving licensure and credentialing discrepancy, health plan network processes and optimizing revenue by facilitating timely ability to bill for provider services.
• Proficiency in clearly conveying complex licensure/credentialing issues to Operations to include timely notification of effective dates. An important component is the ability to clearly convey the RightSite model to facilitate obtaining FFS contracts.
• Strong aptitude for using and adapting to various billing software, electronic health record systems, and data analysis tools. This competency is vital for managing external systems and improving operational efficiency.

Responsibilities

• Verify insurance coverage and ensure accurate loading of insurance information for billing purposes
• Submit claims to our billing partner
• Create invoices for case rates and other billing scenarios as needed
• Perform front-end edits on patient demographics, correcting information such as date of birth, addresses, and member IDs
• Conduct claim audits and reconciliations to ensure all services are accounted for and billed correctly
• Research uninsured and unknown insurance cases to identify potential coverage
• Assist in the implementation and testing of billing automation processes
• Perform ongoing audits of billing automations to ensure accuracy and efficiency
• Serve as a liaison with Operations, identifying opportunities for improvement in front-end data collection
• Serve as a SME (Subject Matter Expert) for Navigators on insurance-related questions

Benefits

• The opportunity to be a part of a dynamic, mission-driven organization
• Competitive base salary
• Market-competitive healthcare coverage, including medical, dental, vision, life, and disability
• The opportunity to work alongside talented and professional colleagues with the ability to grow

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level