Job Summary
The Billing Specialist supports Revenue Cycle Management billing process by administering activities related to claims submittal, denials, and cash applications. Healthcare Billing experience required, ABA Billing experience preferred.

QUALIFICATIONS

• BS or BA degree in Finance, Accounting, healthcare administration or related field, preferred, and/or equivalent work experience in revenue cycle management or medical billing function
• 1 to 3+ years of experience in healthcare within revenue cycle management or medical billing function
• 1 to 3+ years of experience working with Medicaid and MCO’s within medical billing process
• Experience in a high growth and fast paced environments

KNOWLEDGE, SKILLS AND ABILITIES

• Advanced level skills in the use of the Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook eMail and Calendar
• Strong mathematical and analytical skills
• Detail oriented and deadline driven
• Ability to read and analyze ERA remittances for appropriate posting and/or denial resolution actions
• Ability to apply current knowledge to more complex tasks in order to achieve elevated results, leading to continuous improvement
• Proven ability to work and collaborate with other team members and to maintain a positive attitude
• High level of integrity and dependability and the ability to manage multiple projects and competing priorities
• Ability to successfully complete required background and drug screens

• Clean, review, and submit claims for behavioral health providers (specifically autism providers)
• Track claim statuses and remittances
• Work denials and follow up with unpaid claims proactively
• Manage patient responsibility invoices (e.g., patient co-insurance, co-pays)
• Evaluate insurance operations and identify efficiency improvements
• Analyze EOBs and post manual payments
• Submit and follow up on Commercial and Medicaid, primary and secondary insurances
• Communicate to administrative team for errors and corrections
• Work and manage claims from all aging buckets including posting and appeals, including resubmission of claims and appropriate adjustments.
• Input and review billing data for accuracy, including data entry.
• Ensure that billing and collections adhere to all compliance policies and procedures.
• Work with Billing Manager and local clinic team members to ensure accurate billing.
• Follows up on claim resolution from initial billing through final resolution including identifying and correcting billing errors/rejections and denials (denial management investigations & appeals).
• Manage claims submission and AR for assigned clinics.
• Process remittance advices/EOB’s to achieve finalized clean claims for payment including researching and correcting denials (Pull EFT back-ups).
• Post and reconcile payments received using system and deposit reports.
• Maintain confidentiality of all patient information.
• Perform other duties as assigned