Insurance and Billing Specialist

 Billing & ACCOUNTS RECEIVABLE Specialist

Job Description

Department: Billing Department

Reports to: Business Office Manager

Position Summary: The Billing & Accounts Receivable Specialist is responsible for supporting the full revenue cycle for a pediatric neurology practice utilizing eClinicalWorks (ECW) and Waystar. This position focuses on timely claim submission, accounts receivable follow-up, denial management, payment posting, daily reconciliation, patient billing, and insurance collections.

The ideal candidate possesses a strong knowledge of medical billing regulations, payer requirements, and revenue cycle management processes. This individual must be detail-oriented, skilled in problem-solving, and capable of working independently while collaborating with providers, front office staff, credentialing personnel, and management to maximize reimbursement and maintain clean claims.

Required Education and Experience: 

1. High school diploma or equivalent required.
2. Medical Billing and Coding coursework preferred.
3. Minimum one year of medical billing, accounts receivable, or revenue cycle experience preferred.
4. Experience working with electronic health records and practice management systems; eClinicalWorks experience strongly preferred.
5. Experience with clearinghouse systems and electronic claims submission; Waystar experience preferred.
6. Working knowledge of ICD-10-CM, CPT, and HCPCS coding.
7. Understanding of commercial insurance, Medicaid, and managed care plans.
8. Pediatric specialty billing experience preferred.

Essential Skills and Competencies: 

Revenue Cycle Knowledge

• Thorough understanding of claim submission, payment posting, denial management, and accounts receivable workflows.
• Knowledge of timely filing requirements and payer-specific billing guidelines.

Analytical and Problem-Solving Skills

• Ability to investigate unpaid, underpaid, denied, and rejected claims.
• Ability to identify root causes of reimbursement issues and recommend solutions.

Attention to Detail

• Maintains accuracy when entering charges, posting payments, reviewing EOBs/ERAs, and documenting account activity.

Organization and Time Management

• Effectively prioritizes daily claims processing, aging account work queues, reconciliation activities, and follow-up tasks according to the Business Office Manager’s guidelines.

Communication Skills

• Professionally communicates with patients, physicians, insurance payers, and internal staff.
• Documents all account activity thoroughly and accurately within ECW.

Team Collaboration

• Works collaboratively with providers, front office personnel, authorization teams, credentialing staff, and management to resolve billing issues.

Essential Job Responsibilities: 

Claims Processing and Submission

• Review and verify completed encounters for billing readiness.
• Submit electronic claims through eClinicalWorks and Waystar in a timely manner.
• Monitor claim status and correct claim edits, rejections, and clearinghouse errors.
• Ensure claims meet payer-specific requirements prior to submission.
• Assist with medical record and documentation attachment workflows when required by payers. 

Accounts Receivable Follow-Up

• Manage assigned accounts receivable work queues and aging accounts.
• Follow up on unpaid claims through payer portals, phone calls, correspondence, and online resources.
• Prioritize aging balances, including claims exceeding 90, 120, and 180 days.
• Investigate claim delays, medical records requests, coordination of benefits issues, and eligibility concerns.
• Document all collection efforts and payer communications within ECW.

Denial and Appeals Management

• Review insurance denials and identify trends affecting reimbursement.
• Prepare and submit corrected claims, reconsiderations, and appeals with supporting documentation.
• Research payer policies, coding requirements, medical necessity guidelines, and billing regulations to support appeals.
• Collaborate with management and providers to address recurring denial patterns.

Payment Posting and Reconciliation

• Post insurance and patient payments accurately and timely.
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
• Process payment adjustments in accordance with payer contracts and practice policies.
• Participate in daily reconciliation of posted payments, deposits, and bank activity.
• Assist with the preparation and maintenance of daily reconciliation reports and supporting documentation.

Patient Billing and Customer Service

• Assist patients with billing questions and account balances.
• Discuss payment options and payment arrangements consistent with practice policies.
• Generate and monitor patient statements.
• Communicate professionally and compassionately with families regarding financial responsibilities.

Coordination of Benefits and Insurance Verification Support

• Perform patient outreach related to coordination of benefits, demographic updates, and insurance-related corrections.
• Document all outreach attempts in accordance with departmental procedures.
• Assist in resolving eligibility, subscriber information, and coverage discrepancies.

Revenue Cycle Improvement

• Identify workflow issues affecting reimbursement and recommend process improvements.
• Participate in billing meetings, training, and revenue cycle initiatives.
• Maintain knowledge of payer updates, regulatory changes, coding guidelines, and reimbursement trends.
• Assist with cleanup of aging accounts, legacy balances, credit balances, and special projects as assigned.

Documentation and Compliance

• Maintain accurate and complete documentation of all billing activities.
• Follow HIPAA and patient confidentiality requirements.
• Comply with all payer, federal, state, and organizational billing regulations.
• Adhere to established department policies, standard operating procedures, and quality standards.

Performance Expectations: 

• Claims submitted promptly following provider documentation completion.
• Payments posted accurately and reconciled daily.
• Assigned accounts receivable work queues maintained and actively worked.
• Denials and rejections addressed within established departmental timeframes.
• Thorough documentation of all follow-up activity maintained in ECW.
• Positive contribution toward AR reduction, denial prevention, and collection goals.
• Demonstrates initiative in identifying and resolving revenue cycle issues.

Physical Requirements: 

• Extended periods of sitting and computer work.
• Frequent keyboarding and use of office technology.
• Ability to communicate effectively by telephone and in person.
• Ability to occasionally lift up to 20 pounds.
• Visual ability sufficient to review electronic health records, payer correspondence, and financial documentation.

Equal Opportunity Employer: 

THINK Neurology for Kids is an Equal Opportunity Employer and complies with all applicable federal, state, and local employment laws. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, sexual orientation, gender identity, or any other protected status.