The Billing Disputes Team plays an essential role in managing disputes initiated by healthcare facilities (HCFs) related to invoiced shifts. These disputes typically arise from discrepancies in charges that are based on contractual terms and internal records. The Billing Disputes Specialist is responsible for reviewing and processing these disputes to determine whether to accept or reject claims, based on the accuracy of invoices and supporting records provided by the HCFs.

Key Responsibilities

Dispute Management

• Review and resolve invoice disputes submitted by healthcare facilities in a timely and accurate manner.
• Investigate discrepancies in billing and determine if claims should be accepted or rejected based on supporting records.

Contract Review and Verification

• Conduct thorough reviews of facility contracts to ensure that resolutions align with agreed-upon terms.

Communication with Stakeholders

• Make outgoing calls to healthcare facilities to clarify any details related to submitted disputes.
• Send detailed emails to HCFs, Account Managers (AMs), and Billing Representatives (BRs), outlining the outcomes of their submitted disputes.

Collaboration Across Teams

• Work with other Clipboard Health departments to escalate billing discrepancies when disputes require more investigation than within the Billing Disputes Specialist's scope.

Root Cause Analysis

• Identify and analyze the root causes of non-payment to improve future processes and prevent recurring issues.

Required Skills & Qualifications

• Analytical Skills: Strong attention to detail, particularly in reviewing contracts, billing discrepancies, and dispute documentation.
• Communication Skills: Excellent written and verbal communication skills, capable of explaining complex issues to diverse stakeholders.
• Technical Proficiency: Experience with Salesforce, Zendesk, Google Workspace, and other relevant tools for data management.
• Problem-Solving Abilities: Ability to resolve issues efficiently and in a timely manner.
• Organizational Skills: Strong ability to stay organized and manage tasks effectively in a fast-paced environment.
• Customer-Focused: A customer-oriented approach to maintaining positive relationships while adhering to contract terms.
• Experience: 1-2 years of experience in billing, invoicing, or dispute resolution is a plus.

90-Day Success Review

Workflow Mastery

• Achieve a solid understanding of the dispute-handling workflow, including proficiency in tools and proper escalation procedures.

Efficient Discrepancy Resolution

• Quickly identify various types of billing discrepancies and follow the appropriate resolution processes, ensuring the root cause is understood before initiating further investigations.

Systems Proficiency

• Become proficient in using primary tools such as Salesforce, the CBH App, and Zendesk, utilizing them efficiently throughout the dispute resolution process.

Documentation Excellence

• Consistently document post-resolution notes in Salesforce cases and keep the weekly dashboard up-to-date, minimizing unnecessary follow-ups with customers.

Organizational Efficiency

• Organize tasks effectively, ensure timely follow-ups, and adhere to email cadences to improve the dispute resolution process.

Collaboration with Team

• Collaborate actively with the Disputes Team, sharing insights and assisting others. Embrace learning opportunities and maintain a proactive approach to workflow changes.

Meet Performance Metrics

• Consistently meet or exceed team targets and metrics, align personal goals with daily and weekly deliverables, and manage additional cases as necessary to support the team’s success.