Role Title: Insurance Billing Exceptions Specialist (Prompt EMR)

Department: Revenue Cycle Management (RCM)

Role Type: Full-Time / Dedicated Administrative Support

Position Overview

The Insurance Billing Exceptions Specialist serves as the primary owner of all manual revenue cycle interventions within the Prompt EMR environment. While automated features (Prompt Plus) handle standard billing workflows—such as clean claim submissions, automated eligibility checks, OCR intake, auto-posting, waitlist management, and routine patient reminders—this role steps in to manage any workflow requiring human oversight, clinical/billing logic, and active resolution.

The specialist is responsible for troubleshooting and resolving billing exceptions, including claim denials, clearinghouse rejections, authorization flags, dirty ERA/EOB remits, underpayments, secondary claim issues, and system-flagged tasks. Working as the primary RCM link between payers, patients, and the clinic team, the ideal candidate must deliver clear, professional English communication, possess a strong understanding of US medical billing practices, and ensure maximum revenue recovery while escalating only high-level policy or decision-based items to the in-office Admin Support Manager.

Requirements

Core responsibilities

• Work Prompt billing buckets daily: In Review, Hold, Denied/Rejected, Patient Balance, unreconciled remits

• Review AI/auto-post results and correct what the system flagged (partial denials, less-than-set-pay, missing secondary,

requires auth, credentialing hold)

• Add/manage authorizations and scripts on cases; monitor unit-based and visit-limit auths

• Use Prompt eligibility / enhanced benefits verification dashboards; resolve failed or yellow/red eligibility

• Post or correct ERAs when auto-post cannot finish; reconcile remits

• Prepare and send appeals packets; document Last Action

• Use tags, tasks, and notes so the owner and Admin Support Manager can audit in minutes

• Communicate with patients on balances, statements, and benefit questions in a calm, Medicare-friendly tone for those are

older.

• Protect PHI. Unique Prompt login. No shared credentials. HIPAA at all times

• Other duties as assigned

Required qualifications

• Prompt EMR / Prompt Plus experience is required

Hands-on billing in Prompt with AI / automation features used in production: auto-post remittances, eligibility tracking,

benefits verification, authorization-related claim tags, OCR/intake if used

• Fluent English (spoken and written)

• Excellent phone and written communication with older adults, payers, and clinic staff

• Can explain a denial, a patient responsibility, or a next step without jargon

• Comfortable working exception queues and AI Automation oversight (not “I do every claim by hand”)

• Reliable remote setup: private workspace, stable internet, headset, ability to use Weave

Strongly preferred

• Therapy / PT / OT / SLP out of network outpatient billing

• Medicare Part B, Medicare Advantage, Florida commercial payers

• Availity familiarity (verification workflows)

• Experience documenting work so a supervisor can spot-check in 10–15 minutes/day