Billing and Insurance Specialist

OneQuest Health

Billing and Insurance Specialist

Location:
Devou Park

Department:
Billing Services  

Position Reports to:Director of Billing Services          

Position Supervises:
  n/a                       

Profile Last Updated:
December 5, 2025

QUALIFICATIONS

• Minimum of 2 years' experience working in verification of insurance benefits.


• Familiarity with behavioral health services preferred but not required.


• Experience with CareLogic electronic health record system preferred.


• Experience in billing and coding is preferred but not required.


• Demonstrated history of successfully building relationships with insurance companies and their representatives.


• Self-motivated and able to prioritize and identify processes that need to be implemented and/or improved, and tasks that need completion.


• Above-average organizational and time management skills, with great attention to detail.


• Strong verbal and written communication skills.


• Demonstrated proven sensitivity to the various cultural and socioeconomic characteristics of the OneQuest Health clients and staff.


• Valid drivers’ license or other ability to travel between OneQuest Health sites in a timely manner required.
  

POSITION SUMMARY
The Billing and Insurance Specialist is responsible for verifying insurance coverage, benefits, pricing estimates, setting up payment plans for commercial and self-pay clients for OneQuest Health services programs as a priority. Other duties will utilize this position as a backup for other responsibilities in the department such as claim denials and utilization management. Responsibilities include uploading appropriate documentation into the CareLogic EHR system, verification of required insurance coverage and benefits, providing cost estimates for clients, providing back up support in department as needed, contacting clients/guarantors to set up payment arrangements, working with clients with older and larger balances to set up payment plans, and working with other departments as needed to communicate necessary information.

ESSENTIAL JOB FUNCTIONS

1. Upload documentation into the EHR.


2. Input insurance information into the EHR and verify insurance coverage/benefits and coordinate primary and secondary benefits.


3. Participating in verifying patient insurance benefits


4. Provide insurance coverage breakdown of costs, including co-payments, co-insurance, and services needing pre-authorization. Contact insurance companies to gather necessary information for verification and coordination of benefits.


5. Perform as a subject matter expert in reading, understanding, interpreting VOBs (verification of benefits) to advise the team on policies that will not pay enough to cover the daily operation cost per patient.


6. Manage the resolution of insurance billing errors.


7. Back up to other team members in department when needed.


8. Verify Medicaid and other client insurance eligibility monthly or as required.


9. Contact clients/guarantors to set up payment plans prior to services or on past due balances.


10. Send client statements out monthly.


11. Provide back up support to Director of Revenue Cycle Management for insurance concerns.


12. Provide support for other functions in department as needed.


13. Participate in agency Performance Quality Improvement and Quality Assurance Committee activities.


14. Must be able to perform the essential functions of this position with or without reasonable accommodation.


15. Attend training as required.


16. Other duties as assigned.