Medical Billing Specialist

Billing Specialist – Job Responsibilities
As the Billing Specialist at Prosper Women’s Health, you will play a key role in the financial workflow of the practice by ensuring that billing processes are efficient, accurate, and aligned with patient care.

Having a BPO experience with either Athena Health or US Medical Insurance Company is a MUST
Your responsibilities will include:

Claims Management
• Review the Manager Holds Box in Athena daily for:
• Credit card agreements
• Pending charges
• Monitor all filed claims to ensure resolution and timely payment
• Identify recurring claim errors and help implement solutions or escalate for resolution
• Assist in refiling or appealing denied claims when necessary

Surgical Scheduling & Patient Financial Responsibility
• Schedule all surgeries, procedures, and office-based procedures
• Review patient deductibles for upcoming services
• Notify patients when the deductible is over $200
• Confirm insurance coverage and obtain necessary authorizations

Financial Analysis & Strategy
• Gather data on claim trends to support financial decision-making
• Support research into reimbursement for new services (e.g., sonograms) and make recommendations on whether to implement them
• Assist in identifying services that are frequently denied or underpaid and help determine the cause
Other Duties
• Collaborate closely with the clinical and front desk teams to ensure alignment between patient scheduling, billing, and collections
• Help refine financial workflows and recommend improvements to enhance efficiency and collections