Billing Specialist Jobs

About The Position

Requirements

• Strong analytical, problem-solving, and troubleshooting abilities.
• Intermediate proficiency in Microsoft Office applications, particularly Excel.
• Excellent verbal and written communication skills with the ability to explain technical concepts to non-technical audiences.
• Strong organizational skills and attention to detail.
• Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment.
• Self-motivated with the ability to work independently and collaboratively.
• Strong customer service orientation and commitment to quality.

Nice To Haves

• Associate degree in Business, Information Systems, Healthcare Administration, or a related field.
• 1–2 years of Electronic Data Interchange (EDI), enrollment, billing, insurance operations, or related experience.
• Experience working with health insurance exchanges, enrollment reconciliation, or premium billing processes.

Responsibilities

• Process enrollment files received through electronic data feeds and perform account maintenance activities.
• Conduct data reconciliation to ensure accuracy and consistency of information exchanged through EDI in accordance with Federal and State Exchange guidelines.
• Monitor, investigate, and respond to inquiries and escalations from Federal and State Exchanges.
• Submit and reconcile inbound enrollment reconciliation files.
• Create, update, and maintain comprehensive documentation related to exchange processes, procedures, and system changes.
• Establish and maintain EDI procedures and promote best practices across the department.
• Participate in Federal and State Exchange meetings and communicate required operational changes.
• Serve as a Subject Matter Expert (SME) and escalation resource for EDI enrollment and billing issues.
• Ensure the accurate application of Advance Premium Tax Credits (APTC) and individual consumer premium payments.
• Reconcile APTC activity and confirm policies are billed at the appropriate premium rates.
• Perform User Acceptance Testing (UAT) for system enhancements, process improvements, and new exchange-related initiatives.
• Collaborate with internal teams and external business partners to ensure successful file submissions, error resolution, and process improvements.
• Identify, communicate, and escalate critical issues to appropriate stakeholders.
• Partner with Client Experience and Product Services teams regarding client impacts resulting from Federal or State Exchange changes.
• Participate in team meetings, training sessions, and special projects as assigned.
• Maintain knowledge of Wyssta policy processing agreements and client requirements.
• Provide exceptional customer service and respond professionally to enrollment and billing inquiries received via phone, email, web, or other communication channels.

Benefits

• Medical and dental insurance
• 401(k) retirement plan with employer match
• Generous Paid Time Off (PTO) program
• Professional development and cross-training opportunities
• Career growth and advancement potential