Billing & Insurance Specialist

Full-Time | Patient Financial Services

What You'll Do

As a Billing & Insurance Specialist, you will play a critical role in the revenue cycle by ensuring accurate claim submission, timely insurance follow-up, and effective resolution of accounts receivable. You will work collaboratively with Patient Access, Prior Authorization, Revenue Integrity, Coding, Payment Posting, clinical departments, and payer representatives to secure appropriate reimbursement and reduce account aging.

In this role, you will:

Claims Management & Insurance Follow-Up

• Prepare, review, and submit accurate hospital and professional claims according to payer requirements, regulatory standards, and established timelines.


• Monitor billing work queues, clearinghouse responses, claim acknowledgments, claim edits, rejections, and status reports to prevent avoidable delays in reimbursement.


• Follow up with Medicare, Medicaid, commercial insurers, managed care organizations, and other third-party payers regarding unpaid, denied, delayed, or underpaid claims.


• Research account histories, remittance advice, payer portals, authorizations, coding, registration data, and medical records to identify and resolve claim issues.


• Correct and resubmit claims, initiate payer reconsiderations, and prepare appeal documentation within payer filing deadlines.

Accounts Receivable & Revenue Cycle Management

• Maintain complete and accurate account documentation, including payer contacts, reference numbers, actions taken, and required follow-up.


• Review contractual adjustments and investigate payment variances to ensure reimbursement aligns with payer agreements.


• Identify and address coordination of benefits issues, authorization concerns, medical necessity denials, coverage discrepancies, duplicate claims, and other reimbursement barriers.


• Collaborate with Payment Posting, Revenue Integrity, Coding, and Patient Financial Services teams to resolve account issues efficiently.

Process Improvement & Collaboration

• Recognize denial trends, recurring edits, and payer processing issues, escalating concerns and recommending improvements to reduce future denials.


• Participate in account review projects, payer initiatives, cross-training opportunities, and continuous improvement efforts.


• Maintain current knowledge of payer requirements, billing regulations, Medicare and Medicaid guidelines, and organizational policies.


• Communicate professionally with patients, providers, coworkers, and payer representatives to obtain information necessary for claim resolution.


• Protect patient confidentiality and comply with HIPAA, payer contracts, regulatory requirements, and organizational policies.


• Perform all other duties as assigned.

What We're Looking For

We're seeking a detail-oriented professional who enjoys problem-solving, analyzing accounts, and helping ensure accurate reimbursement. The ideal candidate is organized, customer-focused, and able to manage multiple priorities in a fast-paced healthcare environment.

Required Education

• High School Diploma or equivalent

Preferred Education

• Associate or Bachelor's degree in Business, Healthcare, Finance, or a related field

Preferred Licenses & Certifications

• Certified Revenue Cycle Representative (CRCR)

Required Skills & Qualifications

• Strong analytical and problem-solving skills


• Ability to interpret claim edits, remittance advice, payer correspondence, and account histories


• Excellent verbal and written communication skills


• Ability to remain professional during complex payer and patient interactions


• Strong organizational skills with the ability to manage competing priorities and filing deadlines


• Ability to maintain detailed and accurate account documentation


• Commitment to confidentiality, compliance, teamwork, service excellence, and financial stewardship


• Ability to work independently and collaboratively within a team environment

Preferred Experience

• One year of healthcare billing, insurance follow-up, patient accounts, or related revenue cycle experience


• Knowledge of claim forms, insurance benefits, remittance advice, denial management, appeal processes, and accounts receivable workflows


• Experience with Epic or a similar healthcare billing system


• Experience working with clearinghouse tools, payer portals, and Microsoft Office applications