Billing Specialist

The Billing Specialist is responsible for coordinating and overseeing billing operations performed by BostonGene’s billing operations team. The role works closely with BostonGene’s U.S.-based team and external billing partners, navigates complex billing and reimbursement pathways, and provides day-to-day work coordination and quality oversight for other billing team members. The position supports accurate claim processing, payment collection, invoicing, refunds, reconciliation, and documentation throughout the billing cycle. This position is administrative in nature and supports laboratory operations through billing and reimbursement activities. The Billing Specialist does not perform clinical testing, quality control, proficiency testing, result interpretation, result reporting, assay validation, or other activities requiring CLIA personnel qualifications.

Key Responsibilities & Authorities

Billing Operations and Vendor Coordination

• Work closely with BostonGene’s U.S.-based team and external billing partners; communicate clearly across time zones, resolve operational questions, and escalate material risks, delays, or recurring issues.
• Manage and prioritize billing worklists, including data verification, documentation, medical-record, refund, and other follow-up items, and track each item through resolution.
• Upload claim-related documentation and financial assistance determinations to designated billing systems and provide related reports as required.
• Identify and correct invalid or incomplete submissions reported by external billing partners and coordinate with patients, ordering providers, clients, and BostonGene teams to obtain missing billing information or medical records.
• Review and work claim denials and rejections, support or draft appeals, track outcomes, and identify patterns requiring escalation or process improvement.
• Negotiate and accept third-party claim settlement offers within established company parameters and delegated authority; escalate exceptions or higher-risk decisions to U.S. management.
• Complete and maintain billing information in the company’s designated systems, ensuring that statuses, notes, financial information, and supporting documentation are accurate, current, and complete.

Patient Financial Support, Payments, and Invoicing

• Respond to billing inquiries and help patients and ordering providers understand billing steps, insurance benefits, eligibility, financial assistance, and estimated or maximum out-of-pocket responsibility.
• Navigate payer websites, portals, and policies to obtain information needed for billing operations and to support accurate explanations of benefits, eligibility, and patient financial responsibility.
• Collect payments for international and self-pay orders, maintain appropriate payment records, and coordinate with the U.S. team regarding unresolved balances or exceptions.
• Track international orders throughout the billing lifecycle and process or coordinate refunds when an order is canceled or otherwise qualifies for reimbursement.
• Prepare and send invoices to clients, process pathology laboratory invoices, and maintain documentation supporting invoice issuance and payment status.
• Manage billing activities associated with client and other specialized orders and ensure that each order follows the applicable billing pathway and documentation requirements.

Reconciliation, Team Oversight, and Compliance

• Perform billing, charge, and revenue reconciliation; investigate discrepancies, coordinate corrections with external billing partners and internal teams, and document resolution.
• Provide day-to-day operational oversight for other billing team members, including assigning and prioritizing work, reviewing accuracy and completeness, providing guidance and training, and ensuring timely completion of billing tasks.
• Provide backup coverage for essential billing activities and maintain cross-training and workflow continuity during absences, workload fluctuations, or time-sensitive escalations.
• Maintain accurate and complete billing-related records in accordance with company procedures and applicable requirements, and comply with HIPAA obligations to keep Protected Health Information (PHI) secure and private.
• Other duties as assigned.

Qualifications & Competence

Required:

• Education: Bachelor's degree in business administration, healthcare administration, finance, life sciences, or a related field.
• Experience: Prior experience in healthcare billing, reimbursement, insurance verification, claims, patient financial services, payment collection, or related administrative operations.
• Demonstrated ability to navigate complex billing workflows, independently resolve operational issues, and make sound decisions within defined authority.
• Experience coordinating, reviewing, or overseeing the work of other team members.
• Strong written and verbal English communication skills sufficient to work independently with U.S.-based internal teams, patients, providers, payers, and vendors.
• Strong attention to detail, data accuracy, organization, prioritization, and follow-through.
• Ability to protect confidential information and comply with HIPAA and company privacy requirements.

Preferred:

• Experience with Quadax, Salesforce, payer portals, reimbursement worklists, claim documentation, denials, appeals, refunds, or financial assistance workflows.
• Familiarity with MultiPlan, Zelis, international/self-pay billing, invoice processing, and revenue or charge-file reconciliation.
• Ability to work effectively across time zones and in a regulated environment, and to quickly learn and apply changing procedures and proprietary software programs.