Billing Operations Specialist

2 weeks ago

Oklahoma City, Oklahoma, United States Cohesive Healthcare Management Full time
Job Overview

Position Summary:

The role of a Corporate Billing Specialist is essential in maintaining precise and prompt billing operations within a corporate setting. This position requires collaboration with various departments and clients to produce invoices, monitor payments, and address billing issues. The specialist must uphold a high standard of financial accuracy and integrity while fostering positive relationships with clients.

Key Responsibilities:

  • Generate and submit invoices to designated payors and insurance providers.
  • Prepare financial deposits and allocate payments for assigned payors and insurance companies.
  • Address billing inquiries from clients and clinical personnel.
  • Follow up on outstanding balances with relevant payors and insurance companies.
  • Maintain comprehensive records of payment statuses and billing documentation.
  • Identify and rectify billing discrepancies.
  • Recommend write-offs for assigned payors and insurance companies.
  • Compile client billing statements, ensuring accuracy and timely distribution.
  • Analyze and respond to member and provider appeals, ensuring adherence to compliance standards.
  • Manage a caseload and oversee daily compliance with appeal decision timelines.
  • Respond to inquiries from members, providers, and clients regarding the status and outcomes of appeals.
  • Coordinate and assign first, second, and third level appeal requests.
  • Consult with management on complex cases and collaborate with case managers, clinical supervisors, and account managers to resolve denial and appeal issues.
  • Provide timely and accurate responses to appeals, grievances, and related correspondence.
  • Ensure compliance with established regulations in all determination responses.
  • Communicate effectively with teams to guarantee high-quality and prompt handling of customer requests.
  • Assist Customer Service in addressing and resolving customer inquiries related to correspondence.

Qualifications:

  • High school diploma required; a bachelor's degree in accounting, finance, or a related discipline is preferred.
  • Demonstrated experience in billing, invoicing, or accounting roles.
  • Exceptional attention to detail and numerical precision.
  • Strong communication and interpersonal skills.
  • Proficiency in billing software and accounting systems.
  • Familiarity with relevant laws and regulations in the billing sector.
  • Robust problem-solving and analytical skills.
  • Able to work independently as well as collaboratively within a team.
  • Effective time management skills with the ability to prioritize tasks efficiently.

Work Environment:

The physical demands of this position require an employee to perform essential functions successfully. Reasonable accommodations may be made for individuals with disabilities. The work environment is typically clean and well-lit. Employees are regularly required to communicate effectively and frequently use their hands for tasks. Occasional lifting of up to 25 pounds may be necessary. Vision requirements include close, distance, color, and peripheral vision, along with the ability to adjust focus. The noise level in the work environment is generally moderate, and travel to various locations may be required.

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