Billing Specialist ; HYBRID

Position Summary

The Billing Specialist is responsible for obtaining pre‑certification and pre‑authorizations for DME procedure codes by completing the authorization process with commercial payers. The role involves working within the scope of responsibilities as directed by Insurance & Billing leadership teams.

Schedule:

8:00 AM to 4:30 PM EST, Monday through Friday, with one Saturday each month from 9:00 AM to 1:00 PM EST.

Location:

Hybrid in Doral, FL, with the first 90 days fully onsite.

• Initiates Prior Authorization submissions and completes all follow‑ups for all insurance payors including Medicare Advantage, Medicaid, HMO, PPO, and commercial insurers until the case has reached a determination.
• Compiles pre‑certification information to submit prior authorization requests via outbound phone calls and/or web‑based sites (familiarity with payors).
• Performs regular follow‑up calls with insurance companies to check the status of prior authorization requests and logs approvals in the database.
• Conducts outbound and/or inbound calls to patients, doctors’ offices, and insurance companies as necessary to complete tasks.
• Ensures proper documentation is received and recorded before processing additional supplies to patients, per compliance guidelines.
• Ensures accurate entry and updates changes as requested by physicians and/or patients.
• Maintains working knowledge of billing guidelines and resources for Medicare and private insurances.
• Recognizes and reviews billed orders to effectively request authorization for upcoming refills.
• Researches, follows up, and resolves all open/pending authorizations in a timely manner.
• Develops and maintains knowledge of all products and services offered by the company.
• Complies with HIPAA rules, appropriately safeguarding PHI or other private and confidential information.
• Maintains accurate and detailed notes in the company system.
• Adapts quickly to frequent process changes and improvements.
• Is reliable, engaged, and provides feedback to improve processes and policies.
• Attends all department, team, and company meetings as required.
• Appropriately routes incoming calls when necessary.
• Meets patient service quality standards.
• Embraces and exemplifies ADS core values:
  We grow together, We care, We obsess over the customer experience, We commit, We WOW!
• May perform any additional responsibilities or special projects as required.
• Duties and responsibilities may be subject to change based upon the needs of the department.

• High School diploma or equivalent.
• Knowledge of insurance verification and/or authorization, billing, and processing claims.
• Basic knowledge of billing guidelines and resources for Medicare and private insurance.
• Basic knowledge of insurance portals; familiarity with a variety of medical and/or insurance terms or practices.
• Proficiency in basic math and business calculations.
• Working knowledge of computer/data entry with the ability to learn new systems.
• Basic level of MS Office proficiency.

• Friendly, professional, and effective communication skills; able to calmly present solutions in challenging situations.
• Ability to work well in a team environment that promotes inclusiveness and communication among team members.
• Effective interpersonal skills.
• Clear diction and knowledge of the English language, both written and verbal.
• Detail oriented, highly organized; able to work at a fast, productive pace.
• Service orientation and aptitude to resolve insurance and/or patient matters.
• Self‑directed accountability and reliability.
• Cultural competence.

The employee is required to remain in a stationary position most of the time (stand or sit), use hands to finger, handle, or feel, and talk or hear. The employee frequently stands, walks and reaches with hands and arms. The employee may occasionally stoop, kneel, crouch, or crawl and lift and/or move up to 15 pounds. Specific vision abilities required include close vision and the ability to adjust focus.

Candidates must successfully pass a background check and provide proof of eligibility to work in the United States.

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