Medical Claims and Billing Specialist

About Boulder

Boulder Care is an award-winning digital clinic for addiction medicine, recognized for both innovation and high quality of patient care. Founded in 2017 by CEO Stephanie Strong, our mission is to improve the lives of people with substance use disorders through compassionate, evidence-based care.

We provide Boulder patients with a fully virtual, multidisciplinary care team—including medical providers and peer recovery specialists—who deliver personalized treatment, including medication-assisted treatment (MAT) and ongoing support. Our approach is grounded in clinical excellence, patient-centered care, and a commitment to reducing barriers to recovery. Boulder partners with leading health plans, employers, and community organizations to ensure that our services are accessible and covered for the people who need them most.

Named by Fortune as one of the Best Workplaces in Healthcare, Boulder fosters a culture of kindness, respect, and meaningful work that delivers outstanding patient outcomes and moves the addiction medicine industry forward.

About this role

Boulder Care is seeking a Medical Claims & Billing Specialist who will be responsible for all phases of the revenue cycle, from claims submission through payment posting and denied or outstanding claims resolution. You will also work closely with our Enrollment Team to ensure quick resolution to insurance eligibility issues and other patient billing inquiries. You're a great fit if you are detail-driven and organized with a knack for building and maintaining strong relationships with team members and patients alike.

Success in this role

Essential Functions - 95%

• Ensure accurate and timely billing of all claims to the appropriate third party payers
• Insurance payment posting and account reconciliation
• Identifying and correcting billing errors and resubmitting claims to insurance carriers
• Research/rectify third party denials/edits, requests for information and other related correspondence
• Follow up with patients for outstanding balances, work with them to set up payment plans, or other assistance.
• Act as key contributor to the Revenue Cycle by identifying and reporting inefficiencies and opportunities that enhance revenue flow, decrease denials, and minimize write-offs

Other Responsibilities - 5%

• Other duties as assigned by RCM Leadership

Requirements for the role

• 5+ years of experience in a healthcare setting specific to billing and accounts receivable
• Ability to interpret and apply insurance payer billing guidelines, claim rules, and contract terms
• Proficiency in government, commercial and/or insurance payer claims follow-up, denial resolution, and appeals processes
• CPT and ICD coding knowledge
• Knowledge of ANSI 837 and 835 files, including how to read and interpret
• Exceptional written and verbal communi