As the Billing Specialist, you will play a critical role in supporting the revenue cycle at Ally Medical by collaborating with our third-party billing partner to ensure timely and accurate claim processing, account resolution, and payer compliance. You will handle tasks related to insurance follow-ups, medical records, and account reviews with precision and confidentiality. Your attention to detail and commitment to service recovery will directly support our mission of delivering patient-centered care with integrity and excellence.

Duties/Responsibilities:

Claims Management and Insurance Follow-up

• Perform follow-up on coordination of benefits (COB) and insurance ineligibility issues.
• Update patient insurance details and payer IDs to ensure claims are processed correctly.
• Monitor and resolve outstanding claims assigned to Ally Medical through our third-party billing partner.
• Manage cases involving workers’ compensation and attorney representation, ensuring appropriate documentation and timely follow-up.
• Submit necessary corrections or updates to third-party billing workflows to address claim errors or rejections.

Medical Records and Legal Support

• Address deficiencies in medical records required for claim processing.
• Process attorney requests for medical records and affidavits in compliance with privacy regulations.
• Coordinate timely fulfillment of legal documentation required for injury or litigation-related cases.

Patient Account Management

• Conduct detailed audits of patient statements to ensure billing accuracy.
• Review accounts with high patient balances and escalate as appropriate for resolution.
• Apply approved financial assistance discounts and service recovery adjustments to patient accounts.
• Ensure all patient-facing billing adjustments are well documented and processed in a timely manner.

Collaboration and Documentation

• Communicate effectively with internal teams and our billing vendor to resolve claim and account issues.
• Maintain accurate and timely documentation for all billing activities and follow-ups.
• Assist in tracking and reporting on billing performance metrics to support process improvement.
• Respond to internal inquiries related to insurance or billing discrepancies.

Patient and Payer Communication

• Answer inbound phone calls from patients and payers regarding billing inquiries, account balances, insurance questions, and payment options. 
• Work to resolve caller requests on the first contact when possible, and route inquiries that require escalation to the appropriate team member or department in a timely manner. 
• Provide a compassionate, professional, and patient-centered experience on every call, consistent with Ally Medical's commitment to delivering care with integrity and excellence. 

Required Skills/Abilities: 

• Strong understanding of insurance billing practices, COB policies, and denial management.
• Experience with third-party billing coordination and workflow follow-up.
• Familiarity with legal case billing (e.g., WC and attorney involvement).
• High attention to detail and analytical thinking.
• Clear and professional communication skills.
• Proficiency in EMR systems, billing platforms, and Microsoft Office Suite.
• Ability to manage multiple priorities and deadlines in a dynamic work environment.
• Discretion and integrity when handling sensitive patient and financial data.

Education and Experience:

• Required: High School Diploma or GED
• Preferred: Bachelor’s degree in healthcare administration, Accounting, or a related field
• Minimum of 2 years of experience in medical billing, preferably in an emergency care or acute care environment
• Working knowledge of payer guidelines, EOBs, and patient financial policies
• Prior experience with high-balance account review, discounts, and financial assistance programs is a plus

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer. 
• All employees of Ally are responsible for complying with all privacy and security laws and internal policies and procedures. You will play an active role in protecting the company's sensitive data and ensuring that our patient's information is treated with the utmost care and confidence. You are responsible for reporting any concerns or infractions that you become aware of so that the company may appropriately address them. 
• You are responsible for protecting the credentials provided to you to access Company (and customer, where applicable) networks, systems, and data. 
• You are responsible for maintaining the confidentiality of all Ally and customer data to which you are granted access. Any suspected compromises of Ally proprietary data or customer data must be reported to Management immediately. 
• You will adhere to the Company’s Information Security Policy and Procedures and support standard operating procedures to protect Company systems and data. 
• You will alert management immediately with any expected system or data compromises and/or system failure impacting the security, confidentiality, availability, and integrity of Ally Medical and customer data. 
• You will be required to attend an annual Information Security Awareness Training.