Position Title: Enrollment/Billing Representative
Work Location: Remote
Assignment Duration: 04 Months
Work Arrangement: 100% Remote
Schedule Notes: Monday-Friday 8:00 am-4:30 pm EST

This position includes fiduciary duty or access to financial systems: Yes

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Position Summary:

The Collections Specialist is responsible for managing third-party billing and collections, ensuring timely and accurate payment of claims, and processing payer appeals.
This role involves investigating denials, processing rejections, and identifying root causes of payment issues, with the goal of resolving discrepancies and maximizing reimbursement.

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Key Responsibilities:

• Understand Third Party Billing and Collection Guidelines
• Identify root cause of issues and demonstrate recommendations for corrective action steps to eliminate future occurrences of denials
• Meet quality assurance, benchmark standards, and maintain productivity levels as defined by management
• Contact payer, or patient as appropriate
• Documents all collections activity in patient collections notes
• Documents work performed/action taken on AR Reports
• Process all Payer appeal requests within the time frame required by the Payer
• Reviews claim processing to determine proper payment has been issued
• Request and process all approved adjustments
• Processes rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer
• Reviews patient information in appropriate system to determine why the claim is unpaid, if an adjustment is valid, and whether additional approval is required
• Ability to identify errors, correct claims and reprocess for reimbursement
• Ability to read and interpret an EOB for accurate understanding of claim processing
• Knowledge of claims investigation and reviewing payer contracts for reimbursement

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Qualification & Experience (Required Only):

• Knowledge of insurance policies, reimbursement practices, as well as claim processing requirements
• Knowledge of medical billing practices and of medical billing reimbursement
• Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence
• Maintain confidentiality and practice discretion and caution when handling sensitive information
• Multi-task along with attention to detail
• Self-motivation, organized, time-management and deductive problem-solving skills
• Work independently and as part of a team
• Knowledge of Microsoft 365 products, including but not limited to Outlook, Teams and Excel
• Strong customer service skills

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? Non-Negotiable Requirements:

• Insurance Collection Experience (1+ years)
• Denial Management / Denial Resolution (1+ years)
• Medical Billing knowledge (claims, appeals, AR, EOB understanding)
• Microsoft 365 (Excel, Outlook, Teams)

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? Education (Required):

• High school graduate or equivalent

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 19.00/hr.