Healthcare Billing Specialist – US Insurance

About the role

The Healthcare Billing Specialist supports BostonGene’s laboratory operations by managing the full billing cycle for US insurance claims. This administrative position works closely with the U.S.-based team and external billing partners to ensure accurate claim processing, payment collection, invoicing, refunds, and documentation.

Key responsibilities

• Coordinate with BostonGene’s U.S. team and external billing partners, communicating across time zones and escalating material risks or delays.
• Manage and prioritize billing worklists, including data verification, documentation, medical‑record follow‑up, and refunds.
• Upload claim‑related documentation and financial assistance determinations to designated billing systems and generate required reports.
• Identify and correct invalid or incomplete submissions, obtaining missing information from patients, providers, and internal teams.
• Review claim denials and rejections, draft appeals, track outcomes, and flag patterns for process improvement.
• Negotiate third‑party claim settlement offers within company parameters and escalate higher‑risk decisions.
• Maintain accurate billing information in company systems, ensuring up‑to‑date statuses, notes, and supporting documentation.
• Respond to billing inquiries, explain insurance benefits, eligibility, and patient financial responsibility.
• Navigate payer portals to obtain necessary information for accurate explanations of benefits.
• Collect payments for international and self‑pay orders, maintain payment records, and coordinate refunds for canceled orders.

Required profile

• Experience coordinating billing operations and overseeing billing worklists.
• Familiarity with US insurance billing processes and claim submission requirements.
• Ability to communicate clearly with internal teams, external partners, patients, and providers across time zones.
• Strong attention to detail for documentation, claim validation, and financial reconciliation.

Required skills