What are the responsibilities and job description for the Healthcare Billing and Insurance Specialist (Medicare and Commercial) position at 5stone health?
Job Summary
We are seeking an experienced and detail-oriented Healthcare Billing & Insurance Specialist to support patients and families in navigating complex medical billing and insurance issues.
In this role, you will work across Medicare (including secondary coverage) and commercial insurance, helping to identify billing errors, resolve claims, and advocate for accurate reimbursement. You will play a key role in reducing financial stress for patients by bringing clarity, organization, and resolution to often complex situations.
This is not a traditional billing role—we are looking for someone who is proactive, analytical, and solutions-focused, with the ability to independently manage cases and drive issues through to resolution.
Key ResponsibilitiesInsurance & Billing Review
- Review and interpret medical bills, EOBs, and insurance statements
- Identify errors, duplicate charges, and coding discrepancies
- Analyze billing across Medicare, secondary/supplemental plans, and commercial insurance
Claims, Denials & Appeals
- Submit, track, and follow up on insurance claims
- Investigate and resolve denials, delays, and underpayments
- Prepare and manage appeals and prior authorizations
- Escalate complex cases and advocate for appropriate reimbursement
Coordination & Problem Resolution
- Communicate with provider billing departments, hospitals, and physician offices
- Coordinate with insurance companies and payers to resolve issues
- Ensure proper coordination of benefits (COB) across multiple insurers
- Track cases through resolution and maintain clear documentation
Patient Support & Education
- Explain billing and insurance information in a clear, simple, and supportive way
- Guide patients and families through next steps and available options
- Help reduce confusion and stress related to healthcare costs
Qualifications
- 3 years of experience in medical billing, insurance, or revenue cycle management
- Strong experience with Medicare (including secondary insurance) and commercial plans
- Proven ability to manage denials, appeals, and complex billing issues
- Excellent problem-solving and communication skills
- Highly organized and able to work independently
- Experience working with multiple stakeholders (patients, providers, payers)
What We Offer
- Flexible, part-time schedule
- Remote or hybrid work environment
- Meaningful, patient-centered work with real impact
- Opportunity to grow within a care navigation and advocacy model
- Supportive, collaborative, and mission-driven team
Why This Role
This role is ideal for someone who enjoys solving complex problems, advocating for patients, and making a tangible difference in people’s lives by helping them navigate the financial side of healthcare.
Pay: $25.00 - $45.00 per hour
Work Location: In person
Salary : $25 - $45