What are the responsibilities and job description for the Residential Billing Specialist position at ABHS?
The Residential Billing Specialist will play a crucial role in ensuring accurate and timely submission of claims, with a specific focus on Out-of-Network (OON) billing for Behavioral Health services. This role will have a strong emphasis in residential treatment billing and be well-versed in working with insurance payers, verifying benefits, and resolving claim denials.
Key Responsibilities:
- Prepare and submit accurate OON claims for residential behavioral health services.
- Verify patient insurance benefits and eligibility prior to admission and throughout the treatment cycle.
- Track and follow up on claims to ensure timely payment, including appeals and resubmissions.
- Communicate effectively with insurance companies to resolve discrepancies and denials.
- Ensure medical records needed for billing purposes are in client’s charts and/or submitted.
- If claims are denied by the third-party payer, the medical billing specialist must investigate the claim, verify its information, and update the database
- Maintain detailed and organized documentation of all billing activities and payer correspondence.
- Assist with patient billing inquiries and provide exceptional customer service.
- Collaborate with admissions, utilization review, and clinical teams to ensure proper documentation and billing codes.
- Stay up to date with payer guidelines and behavioral health billing regulations.
Requirements:
- Minimum 2 years of experience in behavioral health billing, specifically Out-of-Network residential treatment.
-
High School Diploma or equivalent; Billing and Coding Certification from one of the following national certification exams:
- American Medical Billing Association - Certified Medical Reimbursement Specialist (CRMS) Board Exam
- AAPC - Certified Professional Coder's (CPC®,) Certified Outpatient Coder (or CPC-HCOC™) [formerly CPC-H®,] Certified Inpatient Coder (CIC™,) or Certified Professional Medical Auditor (CPMA®) Board Exam
- American Health Information Management Association - Certified Coding Associate (CCA®,) Certified Coding Specialist (CCS®,) or Certified Coding Specialist Physician-Based (CCS or CCS-P®) Board Exam - The CCS & CCS-P credentials require experience in addition to the education
- Strong knowledge of insurance verification, billing codes (ICD-10, CPT, HCPCS), and claim forms (especially UB04).
- Familiarity with EHR and billing platforms.
- Ability to work independently in a fast-paced, remote environment.
- Excellent communication, organizational, and problem-solving skills.
- HIPAA compliance knowledge and commitment to confidentiality.
Preferred Qualifications:
- Experience with OON negotiation or single case agreements.
- Knowledge of authorization and utilization review processes.
- Prior work with commercial insurance payers in multiple states.
