• Responsible for planning, directing, organizing, monitoring and staffing departmental services. • Oversees and coordinates the insurance billing function, including claims submission, follow-up, and denial management. • Supports staff in maintaining accuracy and timeliness in claims processing. • Develops and implements quality assurance initiatives and monitors compliance with payer and policy requirements. • Conducts regular audits and analyzes performance metrics. • Partners with Revenue Cycle leadership on training and process improvement initiatives.

• Executar análises detalhadas de faturamento, identificando e corrigindo inconsistências; • Realizar rateios personalizados complexos e validar cálculos; • Coordenar o envio e conferência de arquivos com clientes e operadoras; • Acompanhar processos de isenção de copay, garantindo rastreabilidade; • Efetuar e validar lançamentos sistêmicos e assegurar a integridade dos dados entre plataformas (Qbem, Quiver Pro, etc.); • Contribuir para o controle de indicadores de produtividade e qualidade; • Confeccionar o arquivo de folha personalizado de acordo com cliente; • Realizar interface com clientes, operadoras para resolução de ocorrências; • Apoiar a liderança na implantação de melhorias e automações; • Realizar prorrogações de fatura; • Realizar negociação de pleitos junto às operadoras quando necessário; • Treinar e orientar Analista I e II; • Garantir o cumprimento de SLA’s e padrões de qualidade estabelecidos.

Role Description The Billing and Coding Specialist accelerates revenue capture by ensuring clean claims submission, preventing denials before they occur, and proactively identifying coding issues that cause delays. Your success is measured by first-pass claim acceptance rates, reduced denial rates, and faster cash flow achieved through accurate, timely charge entry. This role directly impacts revenue performance by eliminating rework, preventing payment delays, and catching problems before they become costly denials. Core Responsibilities - Maximize Revenue Through Clean Claims Submission - Ensure charges result in clean claims that pay on first submission without denials or rejections - Prevent revenue loss by catching coding errors before claims are submitted - Accelerate cash flow through timely charge entry, enabling faster billing cycles - Apply correct CPT, ICD-10, and HCPCS codes that maximize appropriate reimbursement - Reduce claim rework and resubmissions that delay payment receipt - Maintain high accuracy rates that minimize denials impacting collections - Proactively Identify and Eliminate Recurring Issues - Recognize provider documentation patterns causing repeated coding problems - Escalate systematic issues to prevent ongoing denials and revenue delays - Alert management to trends before they impact multiple claims - Partner with providers to improve documentation supporting clean claims - Identify and communicate training needs that will reduce future errors - Take initiative to solve problems rather than repeatedly coding around them - Drive Quality That Prevents Downstream Revenue Problems - Catch laterality mismatches, documentation gaps, and coding errors before submission - Ensure diagnosis codes support medical necessity, preventing claim denials - Review clinical notes thoroughly to identify issues AR teams would face later - Maintain accuracy standards that eliminate costly denial and appeal work - Perform quality self-checks preventing errors that create collection obstacles - Focus on getting claims right the first time to avoid revenue cycle delays - Accelerate Charge Processing and Reduce Lag Time - Enter charges promptly, enabling timely claim submission and faster payment - Minimize charge lag that delays billing cycles and extends days to payment - Process high volume efficiently while maintaining quality standards - Prioritize work that has the greatest impact on revenue timing - Meet productivity targets supporting departmental cash flow goals - Eliminate backlogs that prevent timely revenue capture - Resolve Documentation Issues That Block Revenue - Identify missing information preventing accurate charge entry - Follow up with providers and clinical staff to obtain documentation needed for coding - Clear obstacles quickly so charges can be processed without delays - Ensure supporting documentation meets payer requirements for reimbursement - Prevent claims from aging in unbilled status due to incomplete information - Drive the resolution of documentation gaps that would cause denials Performance Expectations - Achieve high first-pass claim acceptance rates through coding accuracy - Maintain error rates that minimize denials and collection delays - Process charges within timeframes supporting optimal cash flow - Proactively escalate recurring issues preventing future revenue loss - Meet daily productivity targets, enabling timely billing cycles - Reduce charge lag, minimizing days to claim submission - Contribute to departmental goals for clean claim rates and denial reduction - Demonstrate outcome focus by preventing problems rather than just processing tasks Qualifications - 2+ years of medical billing and coding experience - Strong understanding of CPT, ICD-10, and HCPCS coding systems - Proven ability to maintain high accuracy while processing high volume - Knowledge of medical terminology and clinical documentation - Attention to detail with a focus on preventing errors before submission - Proactive problem-solver who escalates issues and drives solutions - Ability to work independently in a remote environment - Proficiency with MS Office, Excel, and practice management systems Preferred Qualifications - CPC certification or working toward certification - Knowledge of personal injury billing and documentation requirements - Familiarity with NextGen or similar healthcare systems - Track record of high accuracy and low denial rates - Experience identifying and resolving systematic coding issues The Ideal Candidate - Views coding as revenue enablement, not just data entry - Takes ownership of claim outcomes, not just task completion - Proactively identifies problems and escalates before they impact multiple claims - Recognizes patterns and addresses root causes rather than repeating workarounds - Demonstrates urgency around charge timing and its impact on cash flow - Shows initiative in resolving documentation issues that block revenue - Maintains quality focus, understanding that accuracy prevents costly rework - Thinks strategically about preventing denials rather than just processing charges Compensation & Benefits - Competitive hourly rate with performance-based bonus potential - Remote work flexibility - Comprehensive benefits: medical, dental, vision, 401(k) - Professional development support, including certification and continuing education - Clear advancement pathway to Senior Specialist, Auditor, or Team Lead roles Work Environment - 40 hours per week with occasional extended hours to meet deadlines - Fast-paced environment focused on quality and productivity - Regular communication with the team via phone, email, and video conferencing - Self-directed work requiring strong time management and accountability

Role Description RAYUS Radiology is looking for a Customer Service Specialist to join our team. The Customer Service Specialist serves as the primary point of contact for resolving medical billing issues for patient billing responsibilities. You will bridge the gap between patients, insurance companies, and internal departments to explain balances, verify demographics, and optimize Revenue Cycle Management processes with a focus on patient satisfaction. This is a full-time remote position working 40 hours per week. Shifts are 9:30am-6:00pm CST. Essential Duties and Responsibilities - (85%) Patient Billing Customer Service - Assist clinics, referring doctors, attorneys, insurance companies, and patients/responsible parties with medical billing questions. - Research explanation of benefits (EOBs) and/or denials in imaging system to assist patients and explain balances. - Respond to texts, email, and mail regarding billing accounts, problem accounts, general questions, and concerns in a timely manner; route to appropriate departmental resources as needed. - Escalate more complex inquiries to Senior Customer Service Specialist for support and resolution. - Communicate effectively with various departments within Revenue Cycle Management. - Meet or exceed team quality assurance standards. - (10%) Administrative Duties - Email itemized statements and attorneys, requesting letters of protection (LOPs) from attorneys ensuring proper authorization is on file. - Update billing system with updated patient demographic information. - Make calls to referring doctors, patients, insurance companies, and attorneys to receive updated insurance or demographic information on patient accounts. - Research inaccurate and missed adjustments, duplicate charges, reverse collection decisions, and insurance denials. - (5%) Performs Other Duties as Assigned Qualifications - High school diploma or equivalent. - 2 years’ customer service experience. - Proficient with using computer systems and typing. - Proficiency with Microsoft Excel, PowerPoint, Word, and Outlook. - Ability to speak Spanish or other languages in addition to English (preferred). - Health care experience (preferred). Requirements - Knowledge of and adherence to company policies and protocols. - Knowledge of and adherence to HIPAA and safety guidelines. - Knowledge of basic level computer skills; working knowledge of Windows and Microsoft Office Suite products. - Skilled in organizing and prioritizing work and following assignments through to completion. - Skilled in written, electronic, and verbal communication. - Ability to work independently and in a team environment. - Ability to work in a fast-paced environment and meet established deadlines. - Ability to be flexible in schedule and adaptable to constant change. - Ability to effectively handle details with accuracy. - Ability to maintain regular attendance and on-time arrival to work as scheduled. - Ability to deliver high quality customer service to internal and external customers by communicating with integrity and compassion. - Ability to resolve service recovery issues and understand when to escalate to the next level. - Ability to remain calm in challenging situations. - Knowledge of third-party payors. - Ability to convey complex subject matter clearly. - Ability to use office equipment such as computers, printers, scanners/copiers, fax machines, and telephones. Benefits - Medical, dental, and vision insurance. - 401k with company match. - Life and disability insurance. - Tuition reimbursement. - Adoption assistance. - Pet insurance. - PTO and holiday pay. - Many more benefits (based on eligibility).