Insurance & Medical Billing Specialist
About The Position
At Richmond Aesthetic Surgery and Dermlounge, we believe that a patient’s journey to confidence should be seamless—from the first consultation to the final billing statement. We are seeking a proactive, detail-oriented Insurance Medical Billing Specialist to serve as a pivotal link between our clinical excellence and financial integrity. This is not just a data-entry role; you are a revenue cycle champion and a patient advocate. You will navigate the complexities of plastic surgery and weight loss coding and insurance regulations (including the No Surprises Act) to ensure our practice thrives and our patients have total peace of mind.
Requirements
- Experience: Minimum of 3 years as an Insurance Specialist with a deep understanding of in-network/out-of-network claims, denials, and appeals.
- Technical Proficiency: Experience with practice management software and EHRs (NexTech experience is a significant plus). Familiarity with TriZetto and Availity clearinghouses.
- Regulatory Expertise: Strong knowledge of HIPAA, CPT, ICD-10, and HCPCS coding, as well as the No Surprises Act.
- Education: High school diploma required; Associate’s or Bachelor’s degree in Healthcare Administration or a related field is preferred.
- Analytical Mindset: You enjoy the "investigative" work of solving billing discrepancies and optimizing reimbursement.
- Exceptional Communication: You can translate complex insurance jargon into clear, empathetic language for patients.
- Ethical Standard: You uphold the highest level of confidentiality and professional integrity.
- Adaptability: You embrace growth and support organizational changes with a positive, team-oriented outlook.
Nice To Haves
- Specialty Knowledge: At least 1 year in plastic surgery, dermatology, or a similar surgical specialty is highly preferred.
- Education: High school diploma required; Associate’s or Bachelor’s degree in Healthcare Administration or a related field is preferred.
- Technical Proficiency: Experience with practice management software and EHRs (NexTech experience is a significant plus). Familiarity with TriZetto and Availity clearinghouses.
Responsibilities
- Claim Mastery: Prepare and submit specialized medical claims for plastic surgery procedures via clearinghouses (TriZetto/Availity), ensuring accuracy and timeliness.
- Denial Advocacy: Investigate, skillfully appeal, and resolve denied claims, identifying root causes to implement lasting solutions.
- Financial Integrity: Accurately post insurance payments and adjustments while driving success through persistent follow-up on outstanding balances.
- Strategic Analysis: Generate and analyze billing reports to identify trends and uncover opportunities for operational enhancement.
- Authorization Expert: Meticulously verify and secure pre-authorizations for surgeries and office visits to ensure a smooth patient experience.
- Clinical Collaboration: Work alongside clinical staff to ensure documentation robustly supports all billing and meets the highest compliance standards.
Benefits
- You will be an integral part of a premier practice that values Excellence, Service, and Respect.
- As we expand into our new Chesterfield location, you will play a key role in shaping our operational success and ensuring our financial health keeps pace with our clinical growth.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
11-50 employees
