Regional Billing Specialist

General Purpose
The Regional Billing Specialist is responsible for ensuring the accuracy, integrity, and efficiency of accounts
receivable processes across the designated region.

This role serves as a technical expert and oversight
mechanism to maximize collections and minimize aging through proactive claims management and adherence
to payer regulations.

Essential Duties

Claims Management & Billing Accuracy
• Trial Claims: Generate trial claims regularly to identify and resolve billing errors prior to final submission.
• Billing Cycle Oversight: Ensure all prior-month claims are billed immediately following the Triple Check date.
• Unbilled Claims Management: Maintain a cumulative list of all unbilled claims; provide daily updates and documentation until all prior-month claims are successfully released.
• Clearinghouse Maintenance: Review Waystar for rejected claims daily.

Ensure all rejections are corrected and resubmitted within one business day.

Payer Compliance & Revenue Integrity
• Contractual Expertise: Maintain comprehensive working knowledge of payer contracts and rules; ensure all billing aligns strictly with specific contract provisions.
• Payer Sequencing: Review Payer Setup Information reports regularly to identify inaccuracies.

Execute corrections or direct Business Office Managers to resolve errors via the collection note process.
• Denial Management: Monitor insurance portals for status updates and denials.

Execute immediate corrections or submit formal appeals as appropriate to secure payment.

Collections & Cash Application
• Collection Module Oversight: Monitor the PointClickCare Upcoming Activity Tab.

Review outstanding
accounts, initiate new activities, and provide direct feedback/notes to BOMs within the module.
• Account Documentation: Ensure detailed, professional notes are added to all accounts worked within
PCC to maintain a clear audit trail.
• Cash Posting & Reconciliation: Post all payer-appropriate cash to PCC daily.

Perform regular
reconciliations between bank deposits and PCC postings to ensure financial data integrity.

Reporting & Analysis
• Trend Identification: Analyze accounts receivable aging reports to identify negative trends or systemic issues.
• Management Reporting: Keep executive leadership informed by providing concise summaries and actionable insights regarding the region's financial health.

Supervisory Requirements
This role has no supervisory requirements.

Qualification
Education and/or Experience

• 2-4 years of experience in healthcare billing, accounts
receivable, or revenue cycle operations.
• Working knowledge of payer rules, billing regulations, and
claims submission processes.
• Experience with electronic health record (EHR) and billing
platforms (PointClickCare or similar).
• Strong analytical skills with the ability to identify trends,
resolve billing issues, and ensure data accuracy.
• Excellent attention to detail, documentation habits, and
organiz...