Healthcare Billing Specialist
2 weeks ago
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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