MEDICAL BILLING SPECIALIST

Since our opening in 1987, New Hope Treatment Centers has been a welcoming place for young people in moments of crisis. The Medical Billing Specialist position is responsible for accurate and timely processing of medical claims, payment posting, and account reconciliation to support efficient revenue cycle operations. Through accuracy, professionalism, and exceptional customer service, the Medical Billing Specialist supports the organization's mission and financial success.

Essential Duties and Responsibilities

The essential functions include, but are not limited to, the following:

• Prepare, review, and submit accurate claims for services provided by New Hope in a timely manner.
• Monitor and follow up on denied, rejected, or unpaid claims to ensure prompt resolution and reimbursement.
• Communicate with insurance companies, Medicaid, managed care organizations, and other payor sources regarding payment discrepancies, recoupments, denials, and claim corrections.
• Receive electronic remittance advice (ERAs) and explanation of benefits (EOBs), accurately posting payments, adjustments, and denials.
• Research and reconcile billing discrepancies between billed charges and reimbursement amounts.
• Complete account reconciliations and closeout billing for all applicable contract types.
• Establish and maintain billing procedures, workflows, documentation, and contract maintenance processes.
• Maintain accurate billing records and supporting documentation in accordance with organizational policies and regulatory requirements.
• Collaborate with clinical, finance, admissions, and case management teams to resolve billing-related issues.
• Protect the confidentiality of all patients, financial, and organizational information in accordance with HIPAA and applicable privacy regulations.

Competencies

The Medical Billing Specialist must demonstrate competence in the following areas:

• Attention to Detail- Demonstrates excellence by consistently maintaining accuracy in claim preparation, payment posting, account reconciliation, and documentation to support compliant and efficient revenue cycle operations.
• Customer Service- Provides compassionate, respectful, and professional service to patients, insurance representatives, and internal stakeholders, fostering positive relationships and timely issue resolution.
• Accountability - Demonstrates integrity by taking ownership of responsibilities, meeting deadlines, following established policies, and maintaining accountability for quality outcomes.
• Problem Solving- Applies critical thinking to identify billing issues, determine root causes, and implement effective, compliant solutions that improve reimbursement and reduce claim denials.
• Organization & Time Management-Effectively manages competing priorities while maintaining productivity, accuracy, and compliance with departmental timelines.
• Collaboration-Works cooperatively with colleagues across departments to ensure efficient revenue cycle operations and positive organizational outcomes.
• Confidentiality & Integrity- Safeguards protected health information and financial data by maintaining the highest standards of confidentiality, ethical conduct, regulatory compliance, and professionalism in all interactions.

Minimum Qualifications

• High School Diploma or GED.
• Must be at least 21 years of age.
• Ability to pass required background checks, drug screening, and any state-mandated employment clearances.

Preferred Qualifications

• Bachelor’s degree in a related field preferred or 1-year minimum experience in medical billing.
• Minimum of two (2) years of medical billing or healthcare revenue cycle experience preferred.
• Experience with behavioral health, residential treatment, or healthcare billing preferred.
• Experience working with Medicaid, commercial insurance, and managed care organizations preferred.

Required Knowledge, Skills, and Abilities

• Strong interpersonal and communication skills.
• Knowledge of medical billing processes, insurance claims, payment posting, and reimbursement methodologies.
• Understanding of HIPAA regulations and patient confidentiality requirements.
• Strong analytical and problem-solving skills.
• Excellent organizational and time management skills to prioritize multiple tasks while meeting deadlines.
• Proficiency in Microsoft Office Suite and electronic medical record (EMR)/billing systems.
• Ability to work independently while collaborating effectively within a team environment.

Physical and Work Environment Requirements

• Work is performed in an office environment.
• Ability to use standard office equipment.
• Reasonable accommodation may be made to enable qualified individuals with disabilities to perform essential job functions.

#NHTCNCSC