Billing Specialist I (HYBRID)

Southwest Airlines; Honolulu (HI); Hybrid; USD 42,000 - 55,000; Full time

Job summary

Advanced Diabetes Supply is seeking a Billing Specialist to obtain pre-certifications and prior authorizations for DME codes, coordinating with commercial payers. This role operates within Insurance & Billing leadership guidelines to ensure accurate, timely processing.

The ideal candidate will handle insurance verification, billing tasks, and maintain compliant documentation while supporting patients and clinicians in a fast-paced environment.

Qualifications

• Knowledge of insurance verification and/or authorization, billing, and processing claims.
• Basic knowledge of billing guidelines for Medicare and private insurance.
• Familiarity with insurance portals and medical/insurance terms.
• Proficiency in basic math and business calculations.
• Ability to learn new computer systems and data entry tasks.
• MS Office proficiency.

Responsibilities

• Initiates prior authorization submissions and follows up with payors until determination.
• Submits pre-certification information via calls or web portals and tracks status.
• Performs follow-up calls to insurance companies and logs approvals.
• Communicates with patients, doctors, and insurers as needed to complete tasks.
• Ensures documentation is complete and compliant with HIPAA and billing guidelines.
• Maintains accurate notes in the company system and updates medical records as required.
• Remains adaptable to process changes and contributes feedback to improve policies.
• Attends department and team meetings and participates in special projects as needed.

Skills

Insurance verification

Authorization

Billing knowledge

Data entry

Basic math

Computer literacy

Communication

Education

High School Diploma or equivalent

Tools

MS Office

Insurance portals

Job 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 and have a passion for excellence and a bias for action, we may be just what you've been looking for.

Visit us at www.northcoastmed.com to learn more about our company and its culture.

About the Position

Schedule: 8:00 A.M. to 4:30 P.M. EST, Monday through Friday, with one Saturday each month from 9:00 A.M. to 1:00 P.M. EST
Location: Hybrid in Doral, FL, with the first 90 days fully onsite.

Position Summary

The Billing Specialist is responsible for obtaining pre‑certification and pre‑authorizations for DME procedure codes by completing the authorization process with commercial payers. The Billing Specialist will work within the scope of responsibilities as dictated by Insurance & Billing leadership teams.

Essential Functions

• Initiates prior authorization submissions and completes all follow‑ups for all insurance payors including Medicare Advantage, Medicaid, HMO, PPO, and Commercial until the case has reached a determination.
• Compiles pre‑certification information to submit prior authorization requests via outbound phone calls and/or web‑based sites (familiarity with payors).
• Performs regular follow‑up calls with insurance companies to check status of prior authorization requests. Logs approval in database.
• Conducts outbound and/or inbound calls to patients, doctors’ offices, and insurance companies as necessary or required to complete tasks.
• Ensures proper documentation is received and recorded before processing additional supplies to patients, per compliance guidelines.
• Ensures accurate entry and update of changes as requested by physicians and/or patients.
• Maintains working knowledge of billing guidelines and resources for Medicare and private insurances.
• Recognizes and reviews billed orders to effectively request authorization for upcoming refills.
• Researches, follows up, and resolves all open/pending authorizations in a timely manner.
• Develops and maintains knowledge of all products and services offered by the company.
• Complies with HIPAA rules, appropriately safeguarding PHI or other private and 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.
• Meets patient service quality standards.
• Embraces and exemplifies ADS core values: we grow together, we care, we obsess over the customer experience, we commit, and we WOW!
• May perform any additional responsibilities or special projects as required.

Requirements

• High school diploma or equivalent.
• Knowledge of insurance verification and/or authorization, billing, and processing claims.
• Basic knowledge of billing guidelines and resources for Medicare and private insurance.
• 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.

Expected Competencies

• 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.
• Effective interpersonal skills.
• 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. The employee is required to remain in a stationary position most of the time, sit or stand, use hands, talk or hear, and occasionally lift or move up to 15 pounds. Specific vision abilities include close vision and the 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.

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.