Business Office Specialist

# Business Office Specialist (104471)
CORP-Rev Cycle CBO Tyler
- Tyler, TX 75701

Start Date   10/08/2026## Overview Salary Range $18.00 - $20.00 Hourly Position Type Full Time

Travel Percentage None Category Admin
- Clerical## Description
** SECTION 1:

Job Summary (Summary of the basic functions of the position)
** Responsible for medical billing from insurance companies (payors) and patients. Serves as a liaison  between practices, clinics, the business office, payors, and patients. Establishes and maintains contacts  with payor accounts’ representatives. Initiates telephone contact and answer all calls pertaining to  accounts. Maintains accurate information regarding patient accounts receivable. Maintains strict  confidentiality for all patient accounts. Follows approved processes, policies and procedures in executing  job duties.
** SECTION 2:
Duties and Responsibilities (Responsibilities necessary to accomplish job functions)
*** Reviews claims and claim edits in
** Availity
* * and other payer portals to identify and resolve billing errors or rejected claims prior to or following submission.
* Researches and resolves
** claim edits related to missing, invalid, or incorrect NPI information**, including determining the appropriate billing, rendering, or referring provider information required by the payer.
* Uses
** Availity
* * to review payer claim edits, rejection messages, claim status, payer requirements, and other information necessary to resolve billing issues.
* Researches payer-specific requirements through Availity and payer resources to determine the appropriate corrections needed for successful claim submission.
* Corrects applicable claim information in Next Gen and resubmits or routes claims for correction in accordance with established billing procedures.
* Documents claim edit resolution and communicates recurring issues to appropriate billing, coding, credentialing, or management staff.
* Performs
** payer profile/file maintenance in Next Gen
** to maintain accurate payer and insurance information.
* Creates, updates, and maintains payer profiles, including payer names, payer identification numbers, payer addresses, electronic payer information, claim submission information, and other payer-specific billing requirements.
* Ensures all claims are properly bill and clean claim submission through Next Gen  
● Tertiary paper claim printing  
● Ensuring proper provider/location profile setup prior to start date.
* Keys data into computer to maintain billing records and prepare insurance form with data such as names of insurance company and policy holder, policy number, and physician diagnosis.
* Contacts insurance company to verify patient coverage and obtain information concerning extent of benefits.
* Reviews all insurance claim forms for accuracy and correct coding, retrieving and attaching appropriate dictation for claim, as needed.
* Reviews all insurance payments (Explanation of Benefits – EOB’s), including Medicare and Medicaid payments for accuracy in account information and demographics.
* Determines adjustments of claims paid at the out-of-network rate to in-network rates, and processes write-offs on these adjustments.
* Posts all payments, including insurance and patient payments, to appropriate accounts.
* Computes total surgery bill showing amounts to be paid by insurance company and by patient.
* Answers patients' questions regarding statements and insurance coverage, answers telephone in a prompt, courteous, and helpful manner, screening calls, directing calls, providing information, answering questions, and taking accurate messages.
* Responds to all inquiries received from patients and payors either by telephone or written request
* Follows-up on unpaid insurance claims after…