Patient-Side Medical Billing Specialist for Out-of-Network Claim Reimbursement
I am looking for an experienced medical billing specialist to help submit and follow up on out-of-network healthcare claims with Blue Cross Blue Shield.
The initial project involves approximately $2,000 in paid therapy expenses. I have bills and payment records, but need someone to review the documentation, determine what is missing, work with the provider if necessary, prepare the claims correctly, submit them, and follow through until they are processed.
This is patient-side reimbursement work, not routine billing performed for a medical practice.
Initial responsibilities:
- Review my insurance benefits and determine whether the services may qualify for out-of-network reimbursement
- Confirm applicable filing deadlines and requirements
- Review superbills, invoices, receipts, CPT codes, diagnosis codes, provider information, and proof of payment
- Identify missing or incorrect information
- Communicate with the provider’s billing office when necessary
- Prepare and submit claims to Blue Cross Blue Shield
- Track each claim and follow up on delays or requests for additional information
- Correct rejected claims
- Assist with straightforward denials or first-level appeals when appropriate
- Provide a clear summary of amounts submitted, allowed, applied to deductible, reimbursed, or denied
There may be additional smaller medical and behavioral-health claims available after the initial project if the work goes well.
Required experience:
- Direct experience with patient-submitted out-of-network insurance claims
- Experience with Blue Cross Blue Shield claims
- Strong knowledge of superbills, CPT codes, ICD-10 codes, NPIs, explanation-of-benefits documents, and timely-filing rules
- Experience with behavioral-health or therapy claims
- Experience following up on rejected or denied claims
- Strong organization and communication skills
- Ability to protect confidential medical and insurance information
This will be an hourly project with an initial limit on hours. Please describe your relevant experience and your estimate of how many hours the initial review and claim submission will require. Additional time for follow-up, resubmissions, or appeals must be approved in advance.
