Payor Specialist

Ethos Therapy Solutions; Center Square, Northern (PA, KY); Hybrid; USD 29,000 - 34,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Health Savings Account

Life and Disability

401k

Employee assistance programs

Paid time off & holiday pay

Job summary

Ethos Therapy Solutions is seeking a Medical Billing and Collections Specialist in Blue Bell, PA to reduce AR aging and improve cash flow.

The role uses billing software and EHR systems to review claims, verify CPT/HCPCS codes, and communicate with payers and patients to resolve balances. Candidates should be detail-oriented and compliant with HIPAA guidelines.

Qualifications

• Minimum 3-5 years of experience in medical billing and collections.
• Proficiency in medical billing software and electronic health records (EHR) systems.
• Strong understanding of CPT/HCPCS codes and insurance billing procedures.
• Excellent communication skills with patients and payers.
• Detail-oriented with high accuracy in data entry and documentation.
• Ability to work independently and manage multiple priorities in a fast-paced setting.

Responsibilities

• Accounts Receivable Management: Prioritize and collect outstanding balances from insurance companies, government, and patient payers.
• Billing and Coding Review: Verify CPT/HCPCS codes and billing documentation for accuracy and compliance.
• Contract Compliance: Monitor payer adherence and provide insights to optimize performance.
• Claims Processing: Resubmit claims and follow up on denials to ensure timely payment.
• Payer Communication: Explain balances and payment options to patients and payers.
• Insurance Verification: Confirm eligibility and coverage to prevent disputes and denials.
• Compliance and Documentation: Maintain HIPAA-compliant records and confidentiality.

Skills

Accounts Receivable management

Medical billing software

EHR systems

HIPAA compliance knowledge

Communication skills

Education

High school diploma

CPC certification (preferred)

Tools

Medical billing software

Electronic Health Records (EHR)

Job description

Job Details
Job Location: PA - Blue Bell - Blue Bell, PA 19422
Position Type: Full Time
Education Level: High School/GED
Salary Range: $21.00 - $25.00 Hourly
Travel Percentage: Negligible
Job Shift: Day
Job Category: Insurance Collections

Specialist will develop and implement effective collections strategies to reduce accounts receivable aging and improve cash flow. The position will utilize collection software and tools to track progress, prioritize accounts, and elevate collection efforts as needed.

Responsibilities

• Accounts Receivable Management: Manage and prioritize accounts receivable for insurance companies, government and independent/patient payers. Review aging reports, identify delinquent accounts, and take appropriate actions to collect outstanding balances.
• Billing and Coding Review: Review medical billing and coding documentation to ensure accuracy and compliance with industry standards and regulations. Identify discrepancies or coding errors that may have resulted in claim denials or payment delays.
• Contract Compliance: Monitor payer adherence to contractual obligations and elevate issues as needed. Provide insights and recommendations to optimize contract performance and reimbursement rates.
• Claims Processing: Resubmit claims to insurance companies, government and independent payers accurately and in a timely manner. Follow up on pending claims, rejections, and denials to resolve issues and facilitate prompt payment.
• Payer Communication: Maintain positive relationships with patients, insurance companies, and other stakeholders. Communicate with payer/patient regarding their account balances, insurance coverage, and payment options. Aid and guidance to patients in understanding their medical bills and resolving billing inquiries or disputes.
• Insurance Verification: Confirm eligibility, coverage limitations, and any pre‑authorization requirements to prevent claim denials and billing discrepancies arising from changes to patient carrier/plans.
• Compliance and Documentation: Ensure compliance with HIPAA regulations and other healthcare privacy laws in handling patient information and billing records. Document all payment verification activities, including correspondence with payers and internal stakeholders. Protects company value by keeping collection information confidential.

Qualifications

• Minimum of 3-5 years of experience in medical billing and collections, preferably in a healthcare setting.
• Proficiency in medical billing software and electronic health records (EHR) systems.
• Strong understanding of medical terminology, CPT/HCPCS codes, and insurance billing procedures.
• Excellent communication skills, both verbal and written, with the ability to interact professionally with patients, insurance companies, and internal stakeholders.
• Detail-oriented with a high level of accuracy in data entry and documentation.
• Ability to work independently and collaboratively in a fast-paced environment, managing multiple priorities and deadlines effectively.
• Knowledge of healthcare compliance regulations, including HIPAA, Medicare, and Medicaid guidelines.

Education

High school diploma or equivalent required.
Certification in medical billing and coding preferred (e.g., Certified Professional Coder - CPC).

Physical Requirements

• Must be able to remain in a stationary position for extended periods of time
• Ability to sit or stand for extended periods of time
• Constantly operates a computer and other office productivity machinery, such as a copy machine and computer printer
• Ability to travel occasionally by car or commercial flight

Benefits

• Medical, Dental, Vision, Telehealth
• Health Savings Account
• Life and Disability
• 401k
• Employee assistance programs
• Paid time off & holiday pay

Ethos Therapy Solutions is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, gender identity, veteran status, or military status. Ethos Therapy Solutions complies with all applicable federal, state and local laws concerning non-discrimination.