Healthcare Billing Specialist

2 weeks ago


Lexington, Kentucky, United States Complete Staffing Solutions, Inc. Full time
Job Overview

Role Summary of Healthcare Billing Specialist:

  • Execute precise electronic billing processes for commercial insurance, Medicare Advantage, and MassHealth MCOs in accordance with coverage policies and limitations.
  • Manage claim follow-ups, address zero pays, and oversee the health bucket effectively.
  • Collaborate with various departments to investigate and rectify issues following established protocols.
  • Engage with commercial insurance providers, MCOs, and Medicare Advantage plans to ascertain account statuses and facilitate swift resolutions.
  • Address all claim denials and initiate necessary appeals.
  • Investigate customer inquiries related to their accounts.
  • Access online Explanation of Benefits (EOBs) and conduct thorough claims research.
  • Utilize diverse systems for communication, tracking, presenting, and sharing pertinent information.

Qualifications for Healthcare Billing Specialist:

  • At least one year of experience in a patient account representative role within a healthcare facility or medical office.
  • Strong interpersonal skills and a proven ability to work collaboratively within a team.
  • Familiarity with billing requirements of commercial payers (e.g., BCBS, Tufts, HPHC).
  • Understanding of MCOs billing protocols.
  • Experience with Waystar or similar clearinghouse software is highly advantageous.
  • Comprehensive understanding of various payor EOBs.
  • Demonstrated history of effective communication with insurance companies to resolve billing or EOB inquiries.
  • Proficient experience with multiple payor online system access.

Possess moderate to advanced computer skills.



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