Billing Specialist Rep BHS

The Billing Specialist Representative is responsible for securing timely and accurate reimbursement by resolving billing issues with commercial and government payers. This role requires strong critical thinking and analytical skills to identify denial trends, address payment variances, and pursue appropriate corrective actions. Success in this role depends on a proactive, problem-solving mindset and the ability to adapt in a fast-paced, evolving environment.

• MISSION:
  We deliver outstanding care, inspire health, and connect with heart.
• VALUES:
  Trust. Respect. Integrity. Compassion.
• SERVICE GOALS:
  Personally connect. Keep everyone informed. Be on their team.

• Submit timely and accurate claims (UB-04/CMS-1500) to payers, ensuring compliance with regulatory and payer-specific requirements.
• Work claim edits and correct errors in demographic, insurance, and charge data to ensure clean claim submission.
• Conduct prompt and thorough follow-up on outstanding receivables, including appeals and disputes for denials and underpayments.
• Identify and resolve payer over payments in a timely manner to ensure regulatory compliance and prevent future recoupments.
• Analyze denial reasons and payment variances to identify root causes and recommend process improvements.
• Maintain in-depth knowledge of payer guidelines and federal/state regulations.
• Collaborate with payers and internal departments to resolve issues and achieve account resolution.
• Accurately document all actions and communications in the billing system.

• Review patient accounts for accuracy in demographics, insurance coverage, and billing details.
• Identify patterns or trends in denials and reimbursement discrepancies.
• Assist leadership in developing denial prevention strategies and performance improvement initiatives.
• Prioritize and escalate high-risk accounts for timely resolution.
• Demonstrate initiative in recommending improvements to workflow and system efficiency.

• Maintain compliance with HIPAA and all applicable billing regulations.
• Respond to payer communications via phone, portal, and email in a professional and timely manner.
• Collaborate across teams to ensure coordinated resolution of account issues.
• Communicate effectively with patients, coworkers, and external partners, always maintaining professionalism and respect.

Associate’s or Bachelor’s degree in a healthcare or related field preferred. 2+ years of experience in insurance billing and follow-up, with knowledge of UB-04/CMS-1500 claim forms.

• Strong analytical, problem-solving, and organizational skills.
• Effective written and verbal communication abilities.
• Ability to prioritize, manage multiple tasks, and meet deadlines.
• Proficient with Microsoft 365 (Word, Excel, Outlook); experience with patient accounting systems preferred.
• Demonstrated ability to think critically and adapt to changing environments.