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RightSite Health

Navigated non-emergency care reduces ER visits

Insurance and Billing Specialist

Accounts Payable/ReceivablePosted on Nov 10
Full-timeSan Antonio, TX, USANo salary listedIn-person

About the Job

Requirements

  • A bachelor's degree in healthcare administration, business, or a related field, or equivalent experience.
  • At least 2 years of experience in medical billing and insurance verification.
  • Proficiency in medical billing software.
  • Strong knowledge of Current Procedural Terminology (CPT) and International Classification of Diseases, Tenth Revision (ICD-10) coding.
  • Familiarity with Health Insurance Portability and Accountability Act (HIPAA) regulations and privacy standards.
  • Comprehensive knowledge of medical billing practices, insurance claim processes, healthcare reimbursement systems, coding systems, payer requirements, and regulatory compliance.
  • Meticulous accuracy when handling patient information, insurance data, and financial records.
  • Ability to analyze complex billing issues, identify discrepancies, and develop effective solutions.
  • Ability to clearly communicate billing irregularities to health plans and work with them to resolve issues.
  • Strong aptitude for using billing software, Microsoft Excel, and data analysis tools.

Responsibilities

  • Verify insurance coverage and ensure insurance information is accurately loaded for billing purposes.
  • Submit claims to the billing partner.
  • Create invoices for case rates and other billing scenarios as needed.
  • Perform front-end edits to patient demographics, correcting information such as dates of birth, addresses, and member identification numbers.
  • Conduct claim audits and reconciliations to ensure services are accounted for and billed correctly.
  • Research uninsured and unknown-insurance cases to identify potential coverage.
  • Assist with implementation and testing of billing automation processes.
  • Conduct ongoing audits of billing automations to ensure accuracy and efficiency.
  • Liaise with Operations to identify opportunities to improve front-end data collection.
  • Serve as a subject-matter expert for Navigators on insurance-related questions.

About the Company

RightSite Health

Navigated non-emergency care reduces ER visits

RightSite Health helps reduce unnecessary emergency room visits by guiding patients with non-emergency needs to the right care. It relies on a network of Navigators who assist patients in accessing urgent care, clinic appointments, or prescription refills, and who also offer services like roundtrip transportation and follow-up checks. Revenue comes from partnerships with healthcare providers and payors who benefit from lower ER congestion and reduced costs. What sets RightSite Health apart is its navigator-driven, end-to-end care navigation model that integrates transportation and follow-up support to steer patients away from the ER and toward appropriate care options. The company’s goal is to lower healthcare costs, improve patient satisfaction, and decrease avoidable ER visits through coordinated, patient-centered care pathways.

Company size
51-200
Company stage
Early VC
Total funding
$26M
Headquarters
Texas, United States
Founded
Not listed

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