BILLING AND PAYMENT RESOLUTION SPECIALIST chez undefined

About Legent Health

At Legent Health, our mission is simple yet profound: “To provide first-class health care that puts YOU first.”

Our vision reflects our commitment to excellence: “Through robust physician partnerships, become a nationwide leader in compassionate, quality healthcare focused on the patient and available to everyone.”

Our values, also known as our brand pillars, define how we stay true to our identity in the healthcare industry and the communities we serve. These values are central to everything we do:

• Respect: We honor the time and trust of both patients and physicians by delivering organized, efficient services that ensure a seamless healthcare experience.
• Service: We are committed to highly personalized care for patients, their families, and the physicians who serve them, driving optimal outcomes for all.
• Leadership: We strive to be a trusted leader through innovation, clear communication, and unwavering dedication to excellence across our employees and partners.

Joining Legent Health means being part of a team that lives these principles every day, as we build a future focused on compassionate, quality care.

About the Role

We are seeking an experienced Billing and Payment Resolution Specialist to join our revenue cycle team supporting surgical hospital and ambulatory surgery center (ASC) operations. This critical role involves overseeing billing charges, ensuring seamless claims transmission to clearinghouses and payors, performing accurate payment posting, and resolving payment discrepancies. The successful candidate will collaborate with our early out program leader to ensure optimal revenue cycle operations. The ideal candidate will possess advanced proficiency in CPSI/TruBridge, HST Pathways, and professional-level experience with Waystar revenue cycle management systems.

POSITION’S ESSENTIAL RESPONSIBILITIES: 

Billing Operations & Charge Management 

• Review and validate billing charges for accuracy, completeness, and compliance with coding guidelines and payer requirements
• Ensure timely and accurate charge capture for all surgical procedures and related services
• Monitor charge lag reports and collaborate with clinical staff to resolve missing or incomplete charges
• Notify early out program leader of charge description master (CDM) updates and pricing discrepancies
• Perform daily charge reconciliation and exception reporting

Claims Processing & Clearinghouse Management

• Submit claims electronically through clearinghouses to various payors (commercial, Medicare, Medicaid)
• Monitor claims transmission reports and resolve transmission errors
• Track claim status from submission through adjudication
• Manage claim edits, rejections, and clearinghouse error resolution
• Maintain clean claim rates above 98% through systematic pre-submission validation

Payment Posting & Cash Management

• Post payments accurately from electronic remittance advice (ERA) and paper EOBs
• Reconcile daily cash receipts and identify payment variances
• Process contractual adjustments, write-offs, and refunds according to established procedures
• Maintain payment posting accuracy above 99%
• Generate and analyze payment reports for management review

Payment Resolution & Front-End Claims Management

• Handle claim rejections and edits at the clearinghouse level before transmission to payors
• Research and resolve payment discrepancies and short payments for routine claims
• Research and resolve unidentified payments from insurance and patient sources, coordinate with patient access and billing teams to locate appropriate accounts and ensure timely clearing of payment suspense items to support accurate month-end financial reporting
• Process initial claim corrections and resubmissions through clearinghouse systems
• Collaborate with AR specialist for high-level accounts receivable issues requiring advanced resolution
• Communicate with insurance companies for basic claim status inquiries and routine payment issues
• Maintain detailed documentation of all front-end resolution activities
• Escalate complex denial patterns and unresolved payment issues to AR specialist
• Track and report rejection trends and initial resolution rates

Team Collaboration & Coordination

• Collaborate with early out program leader on patient account management and workflow optimization
• Participate in regular team meetings and cross-functional project initiatives
• Provide support and backup coverage for team members as needed
• Communicate effectively with clinical staff, patient access team, and management

System Management & Reporting

• Utilize CPSI/TruBridge, HST Pathways, and Waystar platforms for daily workflow management
• Generate and analyze KPI reports including AR aging, denial rates, and collection metrics
• Maintain data integrity across all revenue cycle systems
• Support system upgrades, implementations, and integration projects
• Create custom reports to support operational decision-making

Compliance & Quality Assurance

• Ensure compliance with HIPAA, No Surprises Act, and other regulatory requirements
• Maintain current knowledge of payer policies and billing regulations
• Support internal and external audits with documentation and data
• Participate in quality improvement initiatives
• Adhere to established policies and procedures for revenue cycle operations

EDUCATION AND EXPERIENCE REQUIREMENTS: 

• High school diploma or GED required; Associate's degree in Health Information Management, Healthcare Administration, or related field preferred
• Current certification required: CPB (Certified Professional Biller) from AAPC or CRCR (Certified Revenue Cycle Representative) from HFMA
• CPC (Certified Professional Coder) certification preferred
• Minimum 3-5 years of healthcare billing experience with surgical hospital and/or ASC environments
• Demonstrated professional-level experience with Waystar revenue cycle management platform
• Knowledge of CPSI/TruBridge systems preferred
• Experience with HST Pathways ASC software preferred
• Proven experience in denial management and payment resolution
• Experience with multiple payer types including commercial, Medicare, and Medicaid
• Advanced proficiency in healthcare revenue cycle management systems
• Strong knowledge of medical coding (CPT, ICD-10, HCPCS)
• Experience with electronic claim submission and clearinghouse operations
• Proficient in Microsoft Office Suite, particularly Excel for data analysis
• Ability to navigate multiple software systems simultaneously
• Experience with electronic remittance advice (ERA) processing
• Strong analytical and problem-solving abilities
• Excellent attention to detail and accuracy
• Effective written and verbal communication skills
• Ability to work independently and manage multiple priorities
• Customer service orientation for patient and payer interactions
• Understanding of healthcare reimbursement methodologies
• Knowledge of regulatory requirements affecting billing operations

Why Join Legent Health?

Legent Health fosters an environment where team members are empowered to deliver exceptional care while growing professionally within a supportive, values-driven culture.

We Offer:

• Competitive salary and performance incentives
• Comprehensive benefits package 
• Paid time off and wellness programs
• Career development and training opportunities

Equal Employment Opportunity (EEO) Statement

Legent Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, disability status, or any other legally protected characteristic.

I-9 and E-Verify Compliance:
 Employment eligibility will be verified through the U.S. Department of Homeland Security’s E-Verify system. All applicants must provide valid documentation to establish identity and authorization to work in the United States, as required by federal law.