Key responsibilities include ability to interpret complex health insurance contracts, understand billing processes, and effectively communicate and resolve escalated payment issues with insurance carriers working within the billing and contracting teams.

• Contract & Benefit Interpretation: Review and apply health insurance contracts to billable services, benefit policy terms, and coverage limitations to determine eligibility and payment eligibility for claims per contract expectations according to benefit parameters.
• Demonstrate billing process expertise to identify and address escalated payment issues as a result of internal billing discrepancies.
• Investigate and resolve escalated payment disputes, including denied, underpaid, or delayed claims, by coordinating with health insurance contract stakeholders as well as internal stakeholders.
• Build data-driven cases to support, justify, and advocate for escalated claims payments.
• Able to review claims submission for internal errors creating escalated payment issues and communicating those details

• Bachelor’s degree in related field preferred
• Experience or strong understanding in contracting & contract management
• Experience in medical or insurance billing with a track record of resolving escalated payment issues.
• Proficiency in billing software, EHR systems, and claims submission platforms.
• Experience of or strong understanding of ICD-10, CPT, modifiers, and insurance payment terms.
• Experience with MPPR/Sequestration, coinsurance and Deductibles
• Coding Certification a plus
• Excellent time management, prioritization and organizational skills
• Experience in Outlook, Word, and PowerPoint desired
• Detail-oriented with strong organizational and problem-solving abilities
• Self-motivated and results oriented
• Proficiency in Microsoft Office applications, including Excel, Word and PowerPoint
• Excellent verbal and written communication and presentation skills
• Mininmal travel

At BrightSpring Health Services, our LEGACY culture guides how we lead, how we serve, and how we show up for one another. We are committed to doing the right thing—leading with integrity, accountability, and transparency in all that we do. As part of this commitment, we share that we may use third-party artificial intelligence (AI) to process employment data in connection with our hiring processes. Any AI tool that we use always has humans in the loop; we do not use AI to automate employment decisions or to discriminate, and we do not use zip codes as proxy. Humans – our hiring leaders and recruiter – make final decisions. BrightSpring Health Services provides reasonable accommodations to qualified applicants and employees with disabilities; if you would like to request a reasonable accommodation, please contact your recruiter or send an inquiry to TalentAcquisition@brightspringhealth.com. For more information about how our company uses AI in the hiring process, contact TalentAcquisition@brightspringhealth.com.

BrightSpring Health Services and its affiliated companies provide 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.

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