Billing Readiness Specialist

Billing Readiness SpecialistThe Billing Readiness Specialist serves as a critical bridge between front office operations, authorization workflows, and the billing department by ensuring patient accounts are accurately configured and financially ready to support timely clean claim submission and continuity of care.This role is responsible for validating insurance setup, payer plan selection, benefit verification, patient financial responsibility, and authorization readiness to ensure claims are routed correctly and reimbursement delays are minimized. The Billing Readiness Specialist proactively identifies account discrepancies that could result in claim denials, incorrect patient balances, delayed reimbursement, or billing errors.In addition to traditional benefit verification responsibilities, this position plays a key role in revenue protection by validating discipline-specific payer requirements, payer crossover configurations, and claim routing logic prior to billing activity.The Billing Readiness Specialist supports clean claim submission, improves point-of-service collection accuracy, and reduces downstream rework by ensuring accounts are properly configured before treatment and billing occur.ResponsibilitiesThe Billing Readiness Specialist is responsible for ensuring patient accounts are accurately configured and financially cleared prior to claim submission and ongoing treatment. This role serves as a critical operational support function between intake, authorization workflows, and billing by validating insurance setup, benefit coverage, payer configuration, patient responsibility, and billing readiness requirements.The Billing Readiness Specialist plays a key role in preventing avoidable denials, improving claim accuracy, reducing patient balance discrepancies, and supporting efficient reimbursement workflows through proactive account review and issue resolution.Insurance & Eligibility VerificationVerify active insurance coverage and eligibilityValidate accurate payer and plan selection within the practice management systemConfirm subscriber/member demographic accuracyReview coordination of benefits and secondary insurance informationEnsure payer setup aligns with discipline-specific billing requirementsBenefit VerificationVerify patient financial responsibility including:CopaysCoinsuranceDeductiblesVisit limitationsReferral requirementsCoverage limitationsAccurately document benefit information within the patient accountPayer Configuration & Billing Readiness ReviewReview patient accounts to ensure proper billing setup prior to claim submissionValidate payer hierarchy and discipline-specific payer routing requirementsIdentify payer crossover issues that may impact claim routing or patient balancesEnsure accounts are configured correctly to prevent billing bypass logic and inaccurate patient responsibility transfersCorrect or escalate account setup discrepancies prior to billing activityAuthorization Readiness OversightConfirm whether authorization is required for services renderedReview authorization status, visit counts, effective dates, and applicable CPT code alignmentIdentify missing, incomplete, or expired authorizationsEscalate authorization concerns to the appropriate operational teamsRevenue Integrity & Denial PreventionPerform pre-billing account audits to identify issues impacting reimbursementPrevent avoidable denials related to registration, payer setup, eligibility, or authorization discrepanciesSupport clean claim submission processes by ensuring account accuracy prior to billingAssist in reducing manual rework and payment delays caused by setup errorsCommunication & CollaborationCommunicate account discrepancies and payer concerns to clinics, front office staff, authorization teams, and billing personnelEscalate recurring trends or operational issues impacting reimbursementCollaborate with operational leadership to improve workflow accuracy and payer setup consistencyAssist with identifying training opportunities related to registration and insurance setup deficienciesQualificationsHigh School Diploma or GED requiredAssociate degree in a related field preferred3+ years of experience in medical billing, insurance verification, authorizations, or healthcare revenue cycle requiredExperience with Medicare, commercial insurance, and managed care preferredOutpatient therapy experience preferredExperience in medical billing, insurance verification, healthcare revenue cycle, or related healthcare operations preferredKnowledge of insurance eligibility, benefit verification, and payer requirementsUnderstanding of authorization workflows and reimbursement processesFamiliarity with outpatient therapy billing workflows preferredStrong attention to detail and organizational skillsAbility to analyze payer setup and account configuration discrepanciesStrong communication and problem-solving skillsExperience with EMR and/or practice management systems preferredPreferred SkillsUnderstanding of discipline-specific payer carve-outs and billing requirementsKnowledge of Medicare, commercial insurance, managed care, and therapy-specific billing workflowsAbility to identify operational trends contributing to denials or delayed reimbursementExperience working in high-volume healthcare billing environmentsKey Performance Indicators (KPIs)Reduction in eligibility-related denialsReduction in authorization-related denialsReduction in payer setup and registration errorsImprovement in clean claim submission ratesAccuracy of patient responsibility configurationTimeliness of billing readiness review completionReduction in manual billing corrections and reworkEscalation resolution turnaround timeAbout Our Line of BusinessBrightSpring Health Services provides complementary home- and community-based health solutions for complex populations in need of specialized and/or chronic care.

Through the Company's service lines, including pharmacy, home health care, and rehabilitation, we provide comprehensive and more integrated care and clinical solutions in all 50 states to over 475,000 customers, clients, and patients daily. BrightSpring has consistently demonstrated strong and industry-leading quality metrics across its services lines, while improving the health and quality of life for high-need individuals and reducing overall healthcare system costs.