Billing Specialist Job Hartford area,Connecticut USA,Healthcare

Job Details:

Job Location:

Hartford, CT 06106, Salary Range: $22.00 - $28.00 Hourly, Position Summary

Key objectives include safeguarding net revenue capture, maximizing clean claim rates, accelerating cash flow, and proactively managing underpayments and denials. The Revenue Cycle Specialist minimizes revenue leakage, actively reduces Days Sales Outstanding (DSO), and ensures strict adherence to HRSA guidelines, Medicaid/Medicare regulations, and HIPAA compliance laws.

Essential Position Duties

Claims Management & Front-End Revenue Capture

Daily Claim Auditing:
Review, scrub, and validate high-volume medical, dental, and behavioral health encounters within eClinical

Works to ensure structural and regulatory compliance prior to payer submission.
Coding Integrity & Quality Assurance:
Audit clinical charts to ensure exact alignment with ICD-10-CM, CPT, and HCPCS Level II coding guidelines, validating proper documentation of modifiers, time-based codes, and FQHC encounter triggers.
Clearinghouse Exception Management:
Monitor and instantly correct electronic front-end edits and clearinghouse rejections to prevent workflow bottlenecks and maintain a clean claim target of >95%.
Data Optimization:
Review, append, and modify patient demographic profiles, insurance coordination of benefits (COB), and sliding fee scale tiers within the practice management system to guarantee accurate upfront adjudication.
Bottleneck Escalation:
Isolate and flag open encounters missing provider signatures, clinical charts, or documentation anomalies, escalating them systematically to providers and the Revenue Cycle Manager to preserve timely filing windows.

Denial Management & Accounts Receivable (A/R) Optimization

Proactive Denial Resolution:
Identify, trend, and appeal unpaid or rejected claims by researching payer-specific policies, utilizing advanced electronic health records (EHR) tools, and executing formal redetermination requests.
A/R Aging Management:
Aggressively audit outstanding insurance balances within designated 30-, 60-, 90-, and 120+ day aging buckets; formulate strategic follow-up queues to extract overdue reimbursements.
Underpayment & Variance Tracking:
Review electronic remittance advices (ERAs) and explanation of benefits (EOBs) against FQHC Prospective Payment System (PPS) rate schedules to detect underpayments or unauthorized contractual adjustive variances.
Payer Policy Surveillance:
Stay current on evolving commercial, Medicaid, and Medicare coverage policies, state filing limitations, and regulatory changes to adjust internal front-end system edits dynamically.
Root-Cause Denial Analysis:
Review, categorize, and track inbound claim denials within eClinical

Works (eCW) using standard CARC (Claim Adjustment Reason Codes) and RARC (Remittance Advice Remark Codes) to identify systemic front-end or clinical documentation vulnerabilities.
End-to-End Appeal Execution:
Draft, assemble, and submit comprehensive, evidence-based appeal packets—including clinical notes, proof of timely filing, and medical necessity documentation to overturn erroneous payer denials and secure maximum reimbursement.

Payment Posting & Financial Reconciliation

Review the posting of all insurance payments and contractual adjustments for accuracy; communicate and resolve any payment discrepancies.
Process and accurately post patient credit card payments, checks, and cash transactions.
Make appropriate financial adjustments, transfer patient balances, and perform fee write-offs in accordance with practice protocols.
Reconcile daily payment postings and accounts receivable.
Prepare and complete daily bank deposits accurately and maintain cash accountability.
Process patient refunds efficiently upon verification of credit balances.

Accounts…