Billing Agent Specialist

Description

SUMMARY/OBJECTIVE:

The Billing Specialist Agent is responsible for supporting professional service billing operations, including insurance claims, patient billing, payment processing, claims submission, denial management, accounts receivable follow-up, and account resolution. This role ensures accurate and timely billing activities, follows up on unpaid claims and outstanding patient balances, and supports effective revenue cycle operations. The Billing Specialist Agent collaborates with patients, insurance companies, providers, and internal departments to resolve billing issues, obtain appropriate reimbursement, maintain accurate account information, and provide responsive customer service. This position is responsible for maintaining accurate documentation, complying with applicable healthcare regulations and organizational policies, and supporting efficient revenue cycle processes. The ideal candidate is detail-oriented, organized, analytical, and customer-service focused, with experience in medical billing, insurance verification, accounts receivable, claims processing, and/or healthcare revenue cycle operations. The successful candidate will demonstrate the ability to manage multiple priorities, investigate billing issues, communicate effectively with patients and insurance representatives, and maintain accuracy in a fast-paced healthcare environment.

RESPONSIBILTIES/DUTIES

Billing & Claims Management

· Prepare and submit claims to insurance companies accurately and in a timely manner.

· Receive and process payments from insurance companies and patients, including posting payments and reconciling accounts.

· Investigate and resolve denied or unpaid claims and resubmit claims when necessary.

· Document and maintain accurate records for each open claim.

· Perform necessary follow-up to ensure proper payment is received.

· Identify, research, and resolve billing issues and account discrepancies.

· Work daily insurance correspondence as needed.

· Work assigned hold buckets and resolve outstanding account items.

· Follow up on the status of past insurance claims and patient accounts.

· Perform collection activities, including contacting patients by phone, correcting claims, and resubmitting claims.

· Verify insurance eligibility for Psychiatry, Neurology, and Primary Care Providers.

· Utilize EMR and billing systems to manage patient information, insurance denials, billing records, and account activity.

Patient & Insurance Support

· Answer patient billing questions and explain invoices, balances, payments, and account activity.

· Assist patients with payment plans and other billing-related inquiries as appropriate.

· Answer questions from patients, coworkers, insurance companies, and other relevant stakeholders.

· Communicate professionally and courteously with patients and insurance representatives regarding account and billing matters.

· Maintain confidentiality of patient, financial, and company information in accordance with HIPAA and organizational policies. 

Revenue Cycle & Operational Support

· Support accurate and timely revenue cycle activities and account resolution.

· Maintain accurate and complete documentation within applicable billing and EMR systems.

· Identify recurring billing issues and communicate potential process improvements to appropriate leadership.

· Follow established billing, collection, documentation, and quality assurance procedures.

· Maintain compliance with HIPAA regulations, billing laws, payer requirements, and organizational policies.

· Meet established productivity, quality, accuracy, and turnaround-time expectations.

· Support departmental goals and operational initiatives.

· Perform other duties and special projects as assigned.

ADA Statement

Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions of this position.

EEOC Disclosure

Salience is an Equal Opportunity Employer and is committed to creating an inclusive workplace. Employment decisions are made without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law. Salience is committed to providing reasonable accommodations to qualified individuals with disabilities and to applicants throughout the hiring process, consistent with applicable law.

Requirements

SKILLS/QUALIFICATIONS

· Ability to provide professional, responsive, and positive customer service.

· Strong understanding of medical billing, insurance claims, accounts receivable, and revenue cycle processes.

· Knowledge of insurance verification and authorization processes.

· Knowledge of medical coding and claims.

· Strong analytical and critical thinking skills.

· Strong attention to detail and accuracy when reviewing claims, account information, payments, and documentation.

· Strong organizational skills with the ability to prioritize multiple projects, accounts, and deadlines.

· Ability to manage time effectively and meet established goals and deadlines.

· Ability to work independently and/or as part of a team in a fast-paced environment.

· Ability to work effectively under pressure while maintaining accuracy and professionalism.

· Strong verbal and written communication skills.

· Professional and courteous telephone manners.

· Ability to exercise sound judgment when addressing billing, insurance, payment, and patient account issues.

· Ability to maintain confidentiality and appropriately manage sensitive patient and financial information.

· Ability to adapt to changing priorities, payer requirements, workflows, and technology.

· Proficiency with computers and the ability to learn and navigate multiple software applications, including EMR and billing systems.

· Experience with Microsoft Office applications and other standard office technology. 

REQUIRED EDUCATION/EXPERIENCE:

· High School diploma or equivalent required.

· 2–4 years of experience obtaining insurance verification and authorizations.

· 2–4 years of experience with medical accounts receivable.

· Knowledge of medical coding and claims required.

· Experience with medical billing, insurance claims, and/or revenue cycle operations preferred.

· Experience working with EMR and medical billing systems preferred. 

ESSENTIAL FUNCTIONS/SKILLS:

Reasonable accommodations may be provided to enable individuals with disabilities to perform the essential functions listed below.

· Prepare, submit, monitor, and follow up on insurance claims to support accurate and timely reimbursement.

· Process insurance and patient payments, including payment posting, account reconciliation, and resolution of discrepancies.

· Investigate denied, unpaid, or delayed claims and determine appropriate corrective actions, including claim correction and resubmission.

· Manage assigned accounts receivable activities and perform timely follow-up on outstanding insurance and patient balances.

· Verify insurance eligibility and accurately document insurance and patient information within applicable systems.

· Review billing records, claims, payment information, insurance correspondence, and account histories to identify errors, discrepancies, and opportunities for resolution.

· Communicate with patients, insurance companies, coworkers, and other stakeholders regarding billing, insurance, payment, and account-related matters.

· Explain billing information and account balances to patients in a professional, courteous, and understandable manner.

· Utilize EMR, billing, insurance, and other computer systems to accurately enter, retrieve, review, and maintain patient and financial information.

· Maintain accurate documentation and records related to claims, accounts, correspondence, follow-up activities, and account resolution.

· Maintain compliance with HIPAA, applicable healthcare regulations, payer requirements, billing guidelines, and organizational policies.

· Prioritize assigned accounts, claims, correspondence, and other work activities to meet established deadlines and productivity expectations.

· Exercise independent judgment when researching and resolving billing and account issues and escalate matters when appropriate.

· Maintain accuracy and attention to detail while performing repetitive, time-sensitive, and high-volume billing activities.

· Collaborate effectively with internal departments, providers, patients, insurance representatives, and other stakeholders to support revenue cycle operations and positive patient experiences.

· Perform other duties and special projects assigned to support departmental and organizational objectives. 

Work Environment/Working Conditions

· Work is performed primarily in a professional office environment.

· Position requires prolonged use of computers, multiple software applications, telephones, and other office equipment.

· Frequent interaction with patients, insurance representatives, providers, coworkers, and other internal and external stakeholders.

· Fast-paced environment with frequent interruptions, competing priorities, high-volume work, and strict deadlines.

· Work may involve interactions with patients who are frustrated, concerned, or having trouble understanding billing or account information.

· Work requires maintaining confidentiality of patient, financial, and company information in accordance with HIPAA and company policies.

· Employee is expected to maintain a professional, respectful, collaborative, and service-oriented work environment.

· Noise level is moderate and consistent with a typical business office.

Cognitive Demands

· Ability to analyze billing, insurance, payment, and accounts receivable information to identify discrepancies and resolve issues.

· Ability to interpret insurance information, claims, payer requirements, billing guidelines, and account documentation.

· Ability to exercise sound judgment and make timely decisions when resolving billing and account issues.

· Ability to prioritize multiple accounts, claims, correspondence, and deadlines while adapting to changing business needs.

· Ability to maintain a high degree of accuracy and attention to detail when reviewing claims, financial information, payment records, and documentation.

· Ability to investigate problems, identify causes of billing discrepancies, and determine appropriate solutions.

· Ability to perform basic mathematical calculations related to payments, balances, adjustments, and account reconciliation.

· Ability to effectively communicate billing and account information verbally and in writing.

· Ability to maintain concentration and accuracy despite frequent interruptions, telephone calls, and competing priorities.

· Ability to learn and apply new billing procedures, payer requirements, software systems, and organizational processes.

· Ability to manage repetitive and detail-oriented tasks while maintaining consistent productivity and quality.

· Ability to maintain confidentiality and exercise discretion when managing sensitive patient and financial information.

Physical Demands

· Frequently sit for extended periods while performing computer-based work.

· Frequently use hands and fingers to operate a keyboard, mouse, calculator, telephone, and other office equipment.

· Frequently communicate verbally and hear conversations in person and by telephone.

· Frequently reach, grasp, and perform repetitive hand and wrist movements.

· Occasionally stand, walk, bend, stoop, or reach while performing job duties.

· Occasionally lift, carry, push, or pull items weighing up to 20 pounds.

· Ability to move throughout the office as needed to perform job responsibilities. 

Vision Requirements

· Ability to read printed materials and electronic documents with or without corrective lenses.

· Ability to perform prolonged computer work requiring close visual acuity.

· Ability to review detailed claims, billing records, account information, spreadsheets, insurance correspondence, and other financial documentation accurately.

· Ability to distinguish numbers, letters, symbols, and other detailed information.

· Ability to shift visual focus between computer monitors, printed documents, and other materials throughout the workday.