Full Time Billing & Claims Specialist

Job Title: Full Time Billing and Claims Specialist

Reports to: Director of Operations

Description: The Billing and Claims Specialist plays a key role in supporting the financial operations of Behavioral Health Clinic (BHC) by managing the full lifecycle of insurance claims and patient accounts. This position is responsible for submitting and processing claims, resolving denials, maintaining accurate accounts receivable, and supporting patient financial communications.

This role also serves as a resource for patients by providing clear, compassionate guidance regarding billing, insurance coverage, and financial responsibility. The Billing and Claims Specialist works collaboratively with clinicians, front office staff, and insurance companies to ensure accurate billing practices, timely reimbursement, and a positive patient financial experience.

Duties and Responsibilities:

Claims & Billing Operations

• Submit insurance claims using the Electronic Health Record (EHR) and claims processing systems
• Oversee accurate coding of services using ICD-10 and DSM-5 guidelines
• Enter and reconcile payments (ERA, EFT, and manual payments)
• Run billing cycle reports and monitor claim status
• Research payer policies, coding rules, and reimbursement guidelines to ensure compliance
• Prepare and distribute billing statements
  
  
  

Denials Management & Issue Resolution

• Review, research, and resolve denied and rejected claims
• Work directly with insurance companies to correct and resubmit claims
• Identify trends in denials and collaborate with internal teams to prevent future issues
• Coordinate with front office and clinical staff to resolve documentation or insurance discrepancies
  
  
  

Accounts Receivable & Patient Financial Management

• Review patient accounts regularly to identify outstanding balances and initiate follow-up
• Ensure accurate setup of patient financial accounts, including correct insurance sequencing (primary/secondary)
• Contact patients regarding balances, insurance issues, or payment options via phone, email, and mail
• Establish and monitor payment plans, including follow-up on missed payments
• Assist patients in understanding billing statements, EOBs, and financial responsibility with clarity and empathy
• Manage patient collections processes, including preparation of accounts for third-party collections in alignment with clinic policies
• Serve as a point of contact for collection agency coordination
  
  
  

Compliance & Documentation

• Maintain accurate and timely documentation of all account activity within the EHR and billing systems
• Ensure compliance with HIPAA, financial privacy laws, and ethical billing practices
  
  
  

Additional Responsibilities

• Collaborate with internal teams to improve billing workflows and reduce errors
• Support patient experience through professional, solution-focused communication
• Other duties as assigned
  
  
  

Qualifications:

• High school diploma or equivalent required; associate’s degree in healthcare administration, business, or related field preferred
• 2–5 years of experience in healthcare billing, claims processing, or patient accounts preferred
• Knowledge of medical billing, coding, insurance processes, and accounts receivable workflows
• Experience with EHR and billing systems
• Strong attention to detail, organization, and time management skills
• Excellent written and verbal communication skills, including patient-facing communication
• Ability to work independently and collaboratively
• Proficiency in Microsoft Office and Google Workspace
• Willingness to learn, adapt, and work occasional overtime
  
  
  

Benefits:

• Starting pay range: $24.00 – $28.00 per hour (based on experience)
• Healthcare Benefit Package including Dental, Vision, STD, LTD, and Retirement Plan options
• Supportive and collaborative team environment with opportunities for advancement
• Paid Time Off (PTO) and Holidays
• In accordance with legal requirements and company policies, successful candidates for this position will be required to complete the form I-9, Employment Eligibility Verification, as part of the BHC Onboarding Process*