Billing Specialist - Insurance Collections

Summary

Elite Sports + Orthopedics is seeking a detail-oriented Billing Specialist – Insurance Collections to manage insurance accounts receivable and support timely, accurate reimbursement. The role focuses on researching and resolving outstanding, denied, and underpaid claims, submitting appeals, documenting account activity, responding to billing inquiries, and collaborating with internal teams.

Responsibilities

• Work insurance aging with a primary focus on accounts **61 days and older**, prioritizing timely and consistent follow-up
• Review, communicate, and accurately document insurance denials within the practice management system
• Follow established practice management system guidelines for claim follow-up, including reason codes and designated follow-up dates
• Submit timely and appropriate appeals for denied claims and monitor their status through resolution
• Research and resolve outstanding claim issues, including missing information, processing errors, payer issues, and other barriers to payment
• Identify underpayments or payments that do not meet the contracted or allowed amount and communicate findings to the appropriate supervisor
• Review payer-specific communications, policies, and updates and communicate relevant information to appropriate team members and departments
• Identify trends or recurring issues related to denials, underpayments, or claim processing and communicate findings to management
• Respond professionally and accurately to written and telephone billing inquiries from patients
• Maintain accurate and thorough documentation of account activity and follow-up efforts
• Collaborate with internal departments and team members to resolve billing and insurance-related issues
• Participate in weekly team meetings and contribute to department goals and process improvement
• Maintain confidentiality of patient and financial information in accordance with applicable policies and regulations
• Perform other miscellaneous duties and responsibilities as assigned by management

Skills

• High school diploma required
• Proven record of discussing financial responsibilities and establishing payment plans when necessary
• Comfortable using email and interacting various applications
• Knowledge of Billing and Collections procedures
• Knowledge of CPT and ICD-1O CM coding
• Knowledge of MS Office Suite, especially Word, Excel and Outlook
• Excellent written and verbal communication abilities
• Goal-oriented and strong attention to details
• Knowledge of managed care, commercial insurance, Medicare and Medicaid reimbursement
• Proven knowledge of Explanation of Benefits forms, claim forms and insurance billing process
• College education or trade school preferred
• Experience working in a physician office or hospital billing-type position preferred
• Orthopedic claims experience is preferred

Qualifications

Must Haves

• High school diploma required
• Proven record of discussing financial responsibilities and establishing payment plans when necessary
• Comfortable using email and interacting various applications
• Knowledge of Billing and Collections procedures
• Knowledge of CPT and ICD-1O CM coding
• Knowledge of MS Office Suite, especially Word, Excel and Outlook
• Excellent written and verbal communication abilities
• Goal-oriented and strong attention to details
• Knowledge of managed care, commercial insurance, Medicare and Medicaid reimbursement
• Proven knowledge of Explanation of Benefits forms, claim forms and insurance billing process

Nice to Haves

• College education or trade school preferred
• Experience working in a physician office or hospital billing-type position preferred
• Orthopedic claims experience is preferred

Benefits

• This position will become FULLY-REMOTE after training however until training is complete the position will train at the 2004 Hayes Street Suite 200 location in Nashville, TN.