Billing Specialist

Position Summary

The Billing Specialist is responsible for helping to maintain a healthy, efficient Revenue Cycle Management process for the South Shore Autism Center. This role works as part of the billing team for the company; they assist in all aspects of insurance, state, school district, and private pay billing. The Billing Specialist interacts and collaborates regularly with both the billing, compliance, clinical and finance team.

Essential Job Functions/Responsibilities

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

• Accurately and efficiently process billing and collection activities for an ABA medical billing office
• Generate and submit claims to insurance companies and DPH ensuring compliance with billing guidelines and regulations
• Reconcile and resolve issues related to claims submissions
• Ability to work closely with team members and management to identify and implement process improvement
• Review, verify and confirm insurance coverage and benefits for ABA therapy services
• Collaborate with insurance companies and clients to resolve billing discrepancies and denials
• Create AR weekly reports and maintain pre billing and denial spreadsheets
• Maintain up-to-date knowledge of insurance regulations and coding requirements to ensure accurate and timely billing
• Prepare and submit appeals for denied claims, as necessary
• Monitor and track outstanding balances and follow up with clients for patient responsibility payment
• Maintain accurate and organized billing records and documentation
• Provide excellent customer service to clients, addressing billing inquiries and concerns in a professional and timely manner
• Participates in team meetings and contributes to discussions on system upgrades and billing workflow enhancements
• Create and maintain individual BCBA or LICSW files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
• Assist new employees with completing credentialing applications and submit to all contracted insurance payors
• Update and maintain CAQH accounts
• Process re-credentialing applications for payors
• Meet deadlines and communicate updates regularly with leadership and respective parties
• Run reports and gather data as needed for financial and operating reports
• Other duties as assigned

Level of Responsibility

• Works under general supervision. Makes decisions within clearly prescribed areas referring matters that fall outside that area to others
• Receives client questions and responds within prescribed areas of knowledge

Supervisory Responsibilities

• This position does not supervise other employees

Qualifications (Education/Knowledge, Skills, and Abilities)

• Bachelor’s or Associate’s degree preferred
• Proven experience in medical billing, preferably in an ABA therapy setting
• Strong knowledge of medical billing and coding procedures, including CPT and ICD-10 codes
• Familiarity with insurance guidelines and regulations, including Medicaid and private insurance plans
• Proficient in using billing software and electronic medical record systems, CentralReach knowledge preferred
• Excellent attention to detail and accuracy in data entry and documentation
• Strong organizational and time management skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong written and communication skills
• Excellent interpersonal and organizational skills
• Comfortable working in a fast-paced environment
• Maintain confidentiality at all times

Working Conditions and Physical Effort

The work environment characteristics described here are representative of those an Administrative Assistant encounters while performing the essential functions of this job.

Physical Demands/Efforts

• Work performed is typically sedentary with occasional periods of walking and standing. May require stooping, kneeling and crouching and lifting objects weighing up to 40 pounds.

Mental & Visual Demands

• Work performed by this position requires moderate mental concentration to effectively execute moderately complex tasks
• Work occasionally requires some degree of visual effort for periods of time

Work Environment and Hazards

• Work environment is in a typical office setting free from noise and hazards

Core Values

South Shore Autism Center provides Applied Behavioral Analysis (ABA) services to clients ages 18 months and older in our bright, friendly clinic setting. The SSAC team is a group of talented professionals who are committed to creating the highest quality learning environment for our children and their families.

AMERICANS WITH DISABILITIES ACT

South Shore Autism Center complies with all aspects of the Americans with Disabilities Act (ADA) and state disability laws. This means we will not discriminate against qualified individuals with a disability in any phase of the employment relationship including application for employment, hiring, promotions

Job Type: Full-time

Pay: $55,000.00 - $65,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

Work Location: In person

Salary : $55,000 - $65,000