Billing Specialist II (NAVA)

Base Pay Range:
Job Description:
The Insurance Specialist is a Full Time, Regular position working remote Monday-Friday

Summary: Responsible for addressing large volumes of unpaid or incorrectly paid claims to secure accurate and timely reimbursement. The Billing Specialist II performs advanced claim follow-up, denial resolution and payer issue management with a high degree of accuracy and independence.

General Description: The Billing Specialist II performs complex medical billing functions related to third-party claims. This includes reviewing unpaid claims and denials, rebilling as needed, analyzing payer trends, resolving credit balances, researching patient claim concerns and coordinating solutions for systemic payer issues. This role requires a minimum of one (1) year of insurance, billing or claims experience in a healthcare setting.

Essential Duties/Responsibilities: To perform this job successfully, an individual must be able to perform each duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

- Reviews unpaid claims by calling for payment status, submitting appeals, and correcting / resubmitting claims when necessary.

- Follows up with insurance companies for any unpaid or incorrectly paid services.

- Assists patients with insurance questions when Collections Specialist is not available.

- Writes off uncollectible balances with dollar values as high as $500 (dependent on experience).

- Resolves claim edits (missing claim information) prior to the submission of the claim to insurance companies.

- Works with vendors to resolve payer issues.

- Corrects posting discrepancies to align with payer adjudication.

- Researches payments received but not yet posted.

- Coordinates with credentialing liaison to address provider enrollment issues.

- Attends monthly meetings to stay updated on policies, upcoming changes and communicates relevant information to leadership.

- Works with referring physician offices to obtain retroactive authorizations or referral numbers.

- Contacts clients regarding overdue accounts, provides requested information and communicates charge discrepancies to leadership.

- Participates in peer-to-peer training and quality assurance activities.

- Supports the LLC staff with onsite eligibility inquiries as needed.

- Performs special projects and additional duties as assigned.

Internal Promotion Pathway to Level II

Current Navani employees may be promoted from Billing Specialist I to Billing Specialist II upon meeting all of the following:

- Completion of one (1) full year of continuous service at Navani as an Billing Specialist I

- Consistently meeting or exceeding performance metrics and quality benchmarks for at least six (6) consecutive months.

- Demonstrated ability to manage complex claims, denials, payer follow-up, and problem solving with minimal supervision

- Demonstrated good attendance, meeting departmental standards and maintaining reliability in schedule adherence.

- Recommendation of leadership

(Promotion is not automatic; final approval is at management discretion)
General Duties/Responsibilities:

- Ability to maintain strict confidentiality within the Inland Imaging companies and Inland’s customers.

- Follows all Health and Safety policies and guidelines of Inland Imaging or its partners depending on work location.

- Follows all company policies including those regarding harassment, non-retaliation, discrimination, respectful workplace, and related policies.

- Follows all policies regarding HIPAA, non-disclosure of confidential information and company security.

- Honest, pleasant manner and good personal hygiene.

- Free of alcohol and drug abuse.

- Ability to access multiple worksites in a timely manner.

- Excellent communication and interpersonal skills.

- Detail oriented; ability to multi-task; organized and able to work in a fast-paced environment.

- Demonstrates