Billing Specialist

Position Summary

The Billing Specialist is responsible for ensuring accurate and timely billing processes across multiple payers, funding sources, and patient accounts. Duties may include claim submission, denial resolution, accounts receivable (AR) management, payment reconciliation, benefit verification, credentialing, and payer contract management. Each Billing Specialist may be assigned specific areas of focus, but must also be able to provide coverage for colleagues as needed.

Key Responsibilities

Duties may include any of the following:

• Claims Management
• Prepare, review, and submit timely and accurate claims to Medicaid, Medicare, commercial insurers, and private pay patients.
• Monitor claim acceptance and adjudication through clearinghouses.
• Identify, investigate, and resolve claim denials, rejections, and underpayments.
• Maintain documentation of billing processes and corrective actions.

• Accounts Receivable & Payment Posting
• Manage AR aging reports to ensure timely collections.
• Post electronic and paper remittances/EOBs (Explanation of Benefits).
• Reconcile posted payments with bank deposits and system records.
• Generate and mail/email patient invoices for balances due.

• Benefit Verification & Patient Financials
• Verify insurance benefits for new patients prior to admission.
• Perform monthly reverification of active patient insurance coverage.
• Communicate patient financial responsibility estimates in advance.
• Set up and monitor payment plans, as appropriate.

• Payer Contracts & Credentialing
• Maintain and update existing Medicaid and commercial payer agreements/contracts.
• Research and initiate new payer/funding contracts as directed.
• Assist with credentialing and payer affiliation of new staff (e.g., therapists, prescribers).
• Track contract renewal dates and ensure ongoing compliance.

• Reporting & Compliance
• Assist in preparing billing, AR, and collections reports for management.
• Ensure compliance with payer guidelines, state regulations, and Joint Commission standards.
• Maintain accurate records within the Electronic Health Record (EHR) and clearinghouse.

• Collaboration
• Work with clinical and administrative staff to resolve billing-related issues.
• Support the Billing Manager in process improvement initiatives.
• Provide backup support to peers to ensure uninterrupted revenue cycle operations.

Qualifications Required

• High school diploma or equivalent.
• Minimum of 3 years’ experience in medical billing, including claims submission to Medicaid, Medicare, and/or commercial insurers.
• Experience handling AR, denials, payment posting, and patient invoicing.
• Basic knowledge of Electronic Health Records (EHRs) and clearinghouse systems.
• Strong understanding of insurance verification and payer requirements.
• Proficiency with Google Suite products (Sheets, Docs, Slides, etc.).
• Strong attention to detail, organizational, and problem-solving skills.

Preferred

• Billing and/or medical coding certification (CPC, CPB, CBCS, etc.).
• Prior experience with Kipu (EHR) and CollaborateMD (clearinghouse).
• Familiarity with behavioral health billing and Medicaid-specific rules.
• Knowledge of payer credentialing processes and contract negotiations.

Core Competencies

• Accuracy & Attention to Detail: Ensures claims, payments, and records are processed correctly.
• Time Management: Meets deadlines for claims submission, payment posting, and reporting.
• Adaptability: Flexible in covering varied billing functions as assigned.
• Communication: Professional, clear, and effective with payers, staff, and patients.
• Problem-Solving: Ability to research denials and resolve billing challenges independently.

Job Type: Full-time

Pay: $41,000.00 - $52,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $41,000 - $52,000