Billing Specialist
Posted Updated 6
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Description
Billing Specialist
QuantumCare Wound Care | Nebraska’s Exclusive Independent Wound Care Partner
QuantumCare is transforming the way healthcare is delivered. As a trusted participating provider within the Methodist Health Partners network and Nebraska’s only independent wound care center, we provide comprehensive services designed to support patients throughout every stage of their wound care journey. From advanced wound care and chronic condition management to transitional care, our experienced team brings compassionate, specialized treatment directly to patients—where they live, recover, and thrive.
The Billing Specialist manages the full revenue cycle process for the clinic, with a strong focus on prior authorization, insurance verification (IVR), claims billing, and denial resolution. This role ensures accuracy, timeliness, and compliance across every stage of reimbursement, from initial referral through final payment.
Core Responsibilities
Prior Authorization & Insurance Verification
- Enter new referrals into the EHR/PM system and verify insurance eligibility promptly upon receipt.
- Obtain prior authorization and complete IVR (insurance verification) before the patient's first appointment, for all payers requiring it.
- Track authorization status and renewal timelines to prevent care delays or unbilled visits.
- Proactively follow up on referrals to confirm the referral source, gather missing information, and ensure the patient record is complete and accurate before the first provider visit.
Billing & Claims
- Prepare and submit clean claims in a timely manner, working closely with the Clinic Manager to ensure accurate charge capture.
- Monitor billing, collections, and account receivable data to identify trends, aging issues, and areas for improvement.
- Monitor daily activity on payer portals and the RCM portal, resolving flagged issues promptly.
- Ensure billing and coding practices comply with federal, state, and payer-specific regulations through regular self-audits and reviews.
Denial Management
- Work claim rejections and denials daily, identifying root cause and taking corrective action to maximize reimbursement.
- Submit timely appeals with appropriate documentation and track appeal outcomes.
- Identify recurring denial patterns and recommend workflow or documentation changes to reduce future denials.
Reporting & Collaboration
- Compile billing, collections, and denial data in Smartsheet or Excel, and report to the Practice Manager weekly.
- Serve as a liaison between clinical, billing, and administrative teams to resolve revenue cycle issues.
- Support front desk operations as needed, including patient intake coordination and check-in communication.
- Contribute to the development of systems and workflows that improve revenue cycle efficiency.
- Maintain current knowledge of payer policies, billing regulations, and industry changes.
- Other duties as assigned.
Experience & Qualifications
- Minimum 5 years of relevant experience in medical billing, prior authorization, or revenue cycle management is required.
- Hands-on experience obtaining prior authorizations and completing insurance verification (IVR) is required.
- Demonstrated experience with denial management and claims appeals is required.
- Strong analytical and problem-solving skills, proficiency with billing/financial systems, and excellent written and verbal communication.
- Working knowledge of healthcare billing regulations and payer requirements.
- Ability to work independently and collaborate effectively within a team.
- Experience or familiarity with WoundExpert EMR is a plus.
Equal Opportunity Employer
QuantumCare provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to 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.