Billing Specialist

Company Description

ACCESS® is a 501c3 nonprofit organization offering a wide range of services for individuals with special needs, including evaluation services, full-time education, therapy, and training. Founded in 1994, ACCESS comprises several programs and initiatives such as ACCESS Early Childhood Program, ACCESS Academy, ACCESS Therapy, and Project SEARCH® Arkansas: ACCESS Initiative. The organization serves individuals throughout Arkansas and is based in Little Rock, with additional locations in various cities across the state.

Job Description  

The Billing Specialist is responsible for accurately preparing, submitting, and reconciling claims for all services provided across ACCESS programs. This position ensures compliance with payer requirements, resolves claim errors and denials, and maintains communication with insurance companies, Medicaid, and families to support timely reimbursement. 

The Billing Specialist plays a critical role in maintaining the financial health of the organization by ensuring claims are submitted accurately, payments are received promptly, and billing processes operate efficiently and in accordance with applicable regulations, payer policies, and ACCESS standards. 

ESSENTIAL FUNCTIONS & BASIC DUTIES  

1. Prepares, reviews, and submits claims for all billable services in accordance with payer and ACCESS policies. 
2. Verifies claim accuracy, ensuring correct CPT/HCPCS codes, modifiers, authorizations, and payer source alignment. 
3. Monitors clearinghouse rejections and promptly corrects errors to prevent reimbursement delays. 
4. Posts payments, adjustments, and denials accurately and timely.
5. Reconciles deposits with remittance advices and maintain complete records of all billing and payment activities for reporting and audit purposes. 
6. Reviews and resolves denied, rejected, or partially paid claims by researching payer feedback, correcting errors, and submitting appeals or resubmissions as needed.
7. Tracks recurring issues and communicates patterns or payer-specific trends to the Clinical Billing Manager for process improvement.
8. Ensures authorizations are correctly linked to claims and reflect approved services.
9. Collaborates with the insurance verification and Medicaid eligibility team to confirm coverage, identify inactive pay sources, and secure necessary prior authorizations. 
10. Communicates with Clinical Services Coordinates (CSC) and the Waiver Department as needed to confirm or resolve authorization issues. Recommends and submits write-offs for review and approval by the Clinical Billing Manager. 
11. Identifies and reports accounts with atypical or questionable balances during monthly statement review.
12. Ensures billing practices comply with Medicaid, Medicare, and commercial insurance requirements. 
13. Files and maintains Explanation of Benefits (EOBs), Remittance Advices (RAs), and related correspondence in an organized and secure manner.
14. Assists with insurance verification for new admissions to ensure accurate payment estimates prior to scheduling. 
15. Supports ongoing departmental improvement efforts through open communication, documentation accuracy, and adherence to ACCESS billing procedures.
16. Completes approved in-service and professional development trainings as assigned.
17. Stays informed about updates to payer regulations, billing procedures, and internal processes.
18. Performs other related or assigned duties as needed to support departmental and organizational goals.

COMPETENCIES

Ethics and Integrity: 

• Demonstrates honesty, professionalism, and     adherence to confidentiality.
• Upholds ACCESS mission, values, and standards.

Dependability and Accountability: 

• Follows supervisory direction and meets deadlines.
• Takes responsibility for actions and follows through on commitments.

Communication and Interpersonal Skills:

• Communicates effectively and professionally with staff, families, and payers.
• Maintains composure and objectivity under pressure.

Problem Solving and Initiative:

• Identifies and resolves issues efficiently.
• Gathers and analyzes information skillfully and applies sound judgment.

Organization and Planning:

• Prioritizes and plans activities effectively.
• Demonstrates accuracy, efficiency, and attention to detail.

Teamwork and Collaboration:

• Contributes positively to team efforts.
• Offers and accepts constructive feedback to improve performance and processes.

PHYSICAL DEMANDS

• Frequently required to sit, use hands to handle or feel, and reach with arms and hands.
• Occasionally required to stand, stoop, kneel, crouch, or crawl.
• Must be able to lift or move up to 50 pounds.
• Specific vision abilities include close vision, distance vision, peripheral vision, depth perception, and focus adjustment.
• Work environment noise level is typically moderate.

QUALIFICATIONS

Education/ Certification: 

• High school diploma or equivalent required.
• Additional coursework or certification in medical billing, coding, or healthcare administration preferred.

Experience/ Knowledge required:

• Minimum of one year of billing experience in a healthcare, behavioral health, therapy, or educational setting preferred. 
• Working knowledge of CPT/HCPCS coding,. Medicaid/Medicare billing, and payer requirements.
• Experience with electronic billing systems preferred.

Skills/ Abilities:

• Excellent attention to detail and strong organizational skills.
• Effective written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficient in Microsoft Office and general computer systems.

Ability to problem-solve and work independently while maintaining team 

TRAVEL REQUIREMENTS

• Travel is not required for this position.
• ACCESS drivers are required to maintain a valid Driver’s License, current auto liability insurance and registration, a clean driving record, and physical ability to drive to local locations throughout Arkansas.