Billing & Claims Specialist

Would you be interested in applying your billing and claims knowledge working with a company that offers amazing growth potential? Please read on!

About Crossroads:
Crossroads Health & Cosmetic Center is a growing health, wellness, and aesthetics practice in Goshen, Indiana, led by Joanna Roth, ACNP-BC, FNP-C. Services include functional & holistic care, wellness and weight-loss, hormone therapy, medication management, pediatrics, and cosmetic services. What started off as a one-room healthcare facility has since grown into two locations that serve many aspects of one's life. Crossroads invests in patients' care and personalizes treatment plans specific to every person who walks through our doors.  Our passionate team members walk alongside each of our patients during the journey towards becoming THE best version of themselves.

About the Job:
The Billing and Claims Specialist is responsible for everything insurance for Crossroads. You'll go to bat for us with payers, reading contracts, catching underpayments, and pushing back when an insurer changes the rules, and you'll work our claims like a bulldog, chasing every denial until it's resolved. This seat protects the revenue that keeps our care available. This position is on-site in Goshen to start, with potential to move to remote once the appeals follow-up and payment postings are fully digital.

Responsibilities include:
- Review visit codes against documentation and submit clean claims to commercial payers (Anthem, Aetna, Cigna, UnitedHealthcare, UMR)
- Work denials, submit corrected claims, write and win appeals
- Review payer contracts, monitor payments against contracted rates, and flag/recover underpayments
- Serve as Crossroads' liaison and advocate with insurers; support contract negotiations
- Research and stay current on payer and coding changes, keep our coding guides up to date, and flag any issues to the Leadership Team
- Manage the aging report, patient statements, and payment plans
- Is the go-to person for patient questions about balances, statements, and insurance payments
- Work claims in Office Ally (Practice Mate, Service Center, and EHR 24/7), including correcting rejected claims
- Help move our appeals follow-up and payment posting from paper into our electronic systems
- Report weekly Scorecard numbers and bring issues to the Leadership Team

First 90-Days:
- Clear or write off (with documented reason) any backlogged claims before payer filing deadlines
- Learn Office Ally's Service Center and put its claims tools to work
- Confirm how insurance payments arrive (electronic ERA/EFT vs. paper EOBs and checks) and move payers to electronic where possible

About you:
- Strong background in medical billing/claims in a physician or outpatient practice, including some payer dispute or appeals work
- Working knowledge of CPT, ICD-10, HCPCS, E/M office-visit coding, and modifiers (25, 59)
- Experience with commercial denials, corrected claims, and appeals
- Comfort with an EHR/practice management system and payer portals
- A bulldog's follow-through and the judgment to push back on payers
- Certification required: CPC or CPB (AAPC), or CCS (AHIMA)
- Preferred: CPMA (AAPC, auditor, strong fit for the advocacy half); holding both CPC and CPB; experience with Anthem Indiana, Availity, and Office Ally (EHR 24/7, Practice Mate, Service Center); wellness/HRT practice experience; EOS experience

Core values: Caring Professional / Attitude Matters / Passionate About Health, Wellbeing & Beauty