• Supports daily billing and coding operations by coordinating workflows, monitoring productivity and ensuring accuracy, compliance, and timely claim submission. • Supervise staff, provide training, resolve routine issues, and escalate complex matters to management. • Monitors daily production, quality, and adherence to department standards regarding billing operations, coding, and compliance for the timely submission of clean claims. • Identifies performance trends and recommends improvements. • Provides training and education related to regulatory and billing requirements. • Collaborates with other departments to identify and resolve issues impacting billing or coding. • Exercise independent judgment on day-to-day operational matters; escalate complex, strategic, or cross-functional issues to the Manager or Director. • Conduct audits and reviews of coding processes to ensure adherence to regulatory standards and best practices.

• Follow-up with insurance carriers on underpaid claims by phone; complete follow-up actions as advised • Research claim variances in hospital patient accounting systems (EPIC, Meditech, Cerner, Athena) • Draft appeals to insurance carriers on denied or underpaid claims • Review claim detail including coding, billing and insurance information for discrepancies • Run claims data through various pricing software

• Maintain, implement, and troubleshoot billing applications with a focus on NextGen EPM software. • Import and correct daily interface files from hospital systems and manage data entry for failed files. • Upload and process electronic claim files, insurance verification, and ERA reports. • Review and resolve failed claims within the clearinghouse, mapping payers to electronic payer numbers. • Manage outsourcing of daily self-pay encounter billing, bad debt files, and reconciliation reporting. • Retrieve payment files from credit card vendors and process reports for batching into eBridge. • Resolve or escalate tickets, ensuring clear communication with internal teams and external customers. • Support QA testing, auditing, and development of electronic billing applications. • Monitor dashboards and reporting trends, flagging issues to the Billing Applications Manager. • Act as backup to team members and manager when needed.

• Facilitate the process of client estimate disputes on submitted job files. • Logging, tracking, and ensuring completion of all disputes to ensure responses are timely and in compliance with all applicable contracted timeframes, standard of drying requirements, and company policy is enforced. • Review an estimate based on carrier guidelines • Manage efficient cycle times and quality of estimate reviews timely and in a fair manner. • Examine documents for completeness, accuracy, and conformance to carrier guidelines • Ability to understand and have a solid technical background that includes an exceptional understanding (and possible hands-on experience) in loss estimating, homeowner residential, commercial. mitigation and construction. • Comfortable working in a metrics driven claims environment. • Strong analytical and mathematical ability. • Exercise objective judgment and critical decision making to resolve issues • Note and follow up on discrepancies in files • Effectively communicate with franchises and clients via phone, email, and internal/external systems to accurately bring both parties to agreement on an invoice amount to be paid and the billing dispute closed in a timely manner. • Escalating disputes to the appropriate professional for review to obtain completion and receive Franchise payment. • Conduct thorough investigations of all information provided, by analyzing all the issues involved and obtaining responses and information from internal and external entities • Work as an effective interface/liaison between internal and external customers • Monitor daily and weekly pending reports and personal worklists, ensuring internal & contractual timeframes are met. • Identify areas of potential improvement and provide feedback and recommendations to management on issue resolution, quality improvement, policies and procedures, cost saving opportunities, best practices, and performance issues. • Back up audit team as needed • Back up customer complaints as needed • Perform other duties as assigned or required. • Regular attendance is an essential function of the job.