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Billing Specialist - Clearinghouse Rejections
Fully Remote • Orlando, FL
Description
About Our Company
Advanced Diabetes Supply was founded on the bold principle of creating a knowledgeable, reliable and demonstrably superior diabetes supply company. Our approach, coupled with a commitment to service and innovation, has catapulted Advanced Diabetes Supply to a national leader in the industry. Creating high-performance, adaptive teams requires a relentless commitment to hiring the best. We strive to maintain a casual, fun environment whenever possible, but we don’t just play around. We work hard every day to provide a positive work culture and respectful atmosphere. The standards we set for ourselves are high, and we love to be challenged! If you enjoy working in a collaborative environment, have a passion for excellence and a bias for action, we may be just what you’ve been looking for.
The Billing Specialist is responsible for ensuring timely and accurate submission of claims through the clearinghouse. This role requires a high level of attention to detail and efficiency, with a focus on clearinghouse rejection management. The Billing Specialist works closely with payers, internal teams, and external partners to resolve claim issues, minimize denials, and maximize revenue cycle efficiency.
Essential Functions
- Manages high volumes of claims with exceptional speed and accuracy.
- Reviews and investigates claims for errors and correct demographic, insurance, diagnosis, or CPT code discrepancies.
- Verifies patient eligibility with insurance company when necessary.
- Works through clearinghouse rejections until full resolution, ensuring timely resubmission of claims.
- Proactively follows up on pending claims within a few days of submission.
- Submits paper claims and supporting documentation as required by payers.
- Addresses and resolves all billing issues, including denials and rejections, until final resolution is achieved.
- Communicates effectively with payers, clearinghouses, and other stakeholders to ensure accurate and timely electronic claim submissions.
- Maintains organized records of claims, rejections, and follow-ups while ensuring the workspace is orderly and compliant with departmental guidelines.
- Processes denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third-party policy.
- Collaborates with the billing team and other departments to improve claims processing efficiency.
- Develops and maintains knowledge of all products and services offered by the company.
- Complies with HIPAA rules, appropriately safeguarding PHI or other private & 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.
- Embraces and exemplifies ADS core values:
*We put our people first.
*We serve our members with passion.
*We take ownership.
*We never stop growing.
- 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.
Requirements
- High School diploma or equivalent
- 6 months experience in medical billing
- Knowledge of insurance verification and/or authorization, billing, and processing claims
- Basic knowledge of billing guidelines and resources for Medicare and Private insurances
- 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
- Organizes and maintains order and cleanliness of Billing
- Effective interpersonal skills
- Communicates effectively to payers and/or claims clearinghouse to ensure accurate and timely electronically filed claims as per department guidelines.
- 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
Physical Demands
The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable employees with disabilities to perform the essential functions.
While performing the responsibilities of the job, the employee is required to remain in a stationary position most of the time (stand or sit). While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is frequently required to stand, walk and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.
Other Requirements
- Candidates must successfully pass a background check.
- Candidates must be able to provide proof of eligibility to work in the United States without sponsorship.
Pay Range and Compensation Package
Pay ranges may vary depending on location. Actual compensation depends on education, experience, and relevant skills.
In addition, benefits include:
- FSA and HSA plan with Employer Contribution
- Employer paid EAP
- 401k with 4% Company Match
- Paid Time Off (PTO) Including 7 Paid Holidays and a Birthday Holiday
- On-Site Gym
- In-house Training Programs
- A fun culture in a fast-growing organization!
Equal Opportunity Statement
Advanced Diabetes Supply provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
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