Our Company
BrightSpring Health Services
Overview
The 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.
Responsibilities
The 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 Verification
Verify active insurance coverage and eligibility
Validate accurate payer and plan selection within the practice management system
Confirm subscriber/member demographic accuracy
Review coordination of benefits and secondary insurance information
Ensure payer setup aligns with discipline-specific billing requirements
Benefit Verification
Verify patient financial responsibility including:
Copays
Coinsurance
Deductibles
Visit limitations
Referral requirements
Coverage limitations
Accurately document benefit information within the patient account
Payer Configuration & Billing Readiness Review
Review patient accounts to ensure proper billing setup prior to claim submission
Validate payer hierarchy and discipline-specific payer routing requirements
Identify payer crossover issues that may impact claim routing or patient balances
Ensure accounts are configured correctly to prevent billing bypass logic and inaccurate patient responsibility transfers
Correct or escalate account setup discrepancies prior to billing activity
Authorization Readiness Oversight
Confirm whether authorization is required for services rendered
Review authorization status, visit counts, effective dates, and applicable CPT code alignment
Identify missing, incomplete, or expired authorizations
Escalate authorization concerns to the appropriate operational teams
Revenue Integrity & Denial Prevention
Perform pre-billing account audits to identify issues impacting reimbursement
Prevent avoidable denials related to registration, payer setup, eligibility, or authorization discrepancies
Support clean claim submission processes by ensuring account accuracy prior to billing
Assist in reducing manual rework and payment delays caused by setup errors
Communication & Collaboration
Communicate account discrepancies and payer concerns to clinics, front office staff, authorization teams, and billing personnel
Escalate recurring trends or operational issues impacting reimbursement
Collaborate with operational leadership to improve workflow accuracy and payer setup consistency
Assist with identifying training opportunities related to registration and insurance setup deficiencies
Qualifications
High School Diploma or GED required
Associate degree in a related field preferred
3+ years of experience in medical billing, insurance verification, authorizations, or healthcare revenue cycle required
Experience with Medicare, commercial insurance, and managed care preferred
Outpatient therapy experience preferred
Experience in medical billing, insurance verification, healthcare revenue cycle, or related healthcare operations preferred
Knowledge of insurance eligibility, benefit verification, and payer requirements
Understanding of authorization workflows and reimbursement processes
Familiarity with outpatient therapy billing workflows preferred
Strong attention to detail and organizational skills
Ability to analyze payer setup and account configuration discrepancies
Strong communication and problem-solving skills
Experience with EMR and/or practice management systems preferred
Preferred Skills
Understanding of discipline-specific payer carve-outs and billing requirements
Knowledge of Medicare, commercial insurance, managed care, and therapy-specific billing workflows
Ability to identify operational trends contributing to denials or delayed reimbursement
Experience working in high-volume healthcare billing environments
Key Performance Indicators (KPIs)
Reduction in eligibility-related denials
Reduction in authorization-related denials
Reduction in payer setup and registration errors
Improvement in clean claim submission rates
Accuracy of patient responsibility configuration
Timeliness of billing readiness review completion
Reduction in manual billing corrections and rework
Escalation resolution turnaround time
About our Line of Business
BrightSpring 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. For more information, please visitwww.brightspringhealth.com. Follow us onFacebook (https://www.facebook.com/brightspringHS) ,LinkedIn (https://www.linkedin.com/company/brightspringhealth) , andX (https://x.com/BrightSpringHS) .
BrightSpring Health Services, and our family of brands, provides equal employment opportunity
Job LocationsUS-AZ-PHOENIX | US-TN-NASHVILLE
ID 2026-192797
Line of Business BrightSpring Health Services
Position Type Full-Time
