Enrollment/Billing Representative
Spectraforce Technologies, Raleigh, NC, United States
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
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.
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
Document all collections activity in patient collections notes
Document work performed/action taken on AR Reports
Process all Payer appeal requests within the time frame required by the Payer
Review claim processing to determine proper payment has been issued
Request and process all approved adjustments
Process 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
Identify errors, correct claims and reprocess for reimbursement
Read and interpret an EOB for accurate understanding of claim processing
Knowledge of claims investigation and reviewing payer contracts for reimbursement
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
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)
Education (Required)
High school graduate or equivalent
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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
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.
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
Document all collections activity in patient collections notes
Document work performed/action taken on AR Reports
Process all Payer appeal requests within the time frame required by the Payer
Review claim processing to determine proper payment has been issued
Request and process all approved adjustments
Process 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
Identify errors, correct claims and reprocess for reimbursement
Read and interpret an EOB for accurate understanding of claim processing
Knowledge of claims investigation and reviewing payer contracts for reimbursement
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
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)
Education (Required)
High school graduate or equivalent
#J-18808-Ljbffr