Clinical Support Specialist at ICBD

Lauderdale Lakes, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

14 Jan, 26

Salary

0.0

Posted On

16 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Documentation, Treatment Plans, Medical Records, Utilization Review, Behavior Analysis, Insurance Requirements, Quality Assurance, Communication Skills, Analytical Skills, Problem-Solving Skills, HIPAA Compliance, Collaboration, Patient Care, Regulatory Standards, Healthcare Efficiency, Process Optimization

Industry

Hospitals and Health Care

Description

Clinical Support Specialist – Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental health, and autism care fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies. EBS is poised for exponential growth, and we are building out our teams to support the expansion of global operations. Part of the ICBD family office portfolio, Exact Billing Solutions combines entrepreneurial speed with the financial discipline of a self-funded, founder-led organization. Our growth reflects a proven ability to solve complex healthcare challenges with operational precision, scalable systems, and client-first innovation. Our Origin Story Exact Billing Solutions was launched to address one of healthcare’s most persistent challenges: the burden of billing and insurance administration on providers. With firsthand knowledge of how inefficiencies in revenue cycle management drain resources from patient care, our founder built a company dedicated to removing obstacles, accelerating cash flow, and delivering peace of mind to clients across specialties. Recognition & Awards Exact Billing Solutions contributes heavily to the success of the broader ICBD family office ecosystem and benefits from the recognition awarded to other portfolio companies, including: Inc. 5000, 2024 – Top 5 Fastest-Growing Private Companies in America (ABA Centers of America) EY Entrepreneur Of The Year® U.S. Overall Florida Trend Magazine – 500 Most Influential Business Leaders About the Role The Clinical Support Specialist plays a critical role in promoting high-quality, cost-effective patient care. This position is responsible for assessing clinical documentation, treatment plans, and medical records to ensure appropriate utilization of healthcare services. Responsibilities include identifying opportunities for improvement, supporting compliance with regulatory standards, and collaborating with clinical and administrative teams to enhance overall healthcare efficiency. The principal functions of the position identified shall not be considered as a complete description of all the work requirements and expectations that may be inherent in the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position. Key Responsibilities The following are duties and responsibilities that the Clinical Support Specialist shall provide: Review and evaluate medical records, treatment plans, and clinical documentation for accuracy, completeness, and compliance with established standards and guidelines. Assess the medical necessity and appropriateness of services in accordance with clinical criteria and payer requirements. Conduct live reviews with Board Certified Behavior Analysts (BCBAs), BSBAs, and other healthcare professionals to ensure thorough assessments. Identify and address issues related to overutilization or underutilization of services. Collaborate with interdisciplinary teams, including BCBAs, Registered Behavior Technicians, and other stakeholders to support comprehensive utilization reviews. Communicate findings and recommendations to internal teams and external parties in a clear and professional manner. Prepare, initiate, and manage appeals, peer reviews, pre-certifications, initial and re-authorization requests. Advocate on behalf of clients to support coverage decisions by insurance providers. Ensure electronic medical records (EMR) are accurate and up to date, particularly in relation to utilization review activities. Verify and record all necessary insurance information to support billing and reimbursement processes. Coordinate with the clinical team to maintain continuity and quality of care. Participate in quality improvement initiatives and contribute to process optimization efforts. Stay current with relevant healthcare regulations, accreditation standards, and payer policies. Maintain compliance with all applicable laws, regulations, and organizational policies related to utilization review. Qualifications The Clinical Support Specialist requires a Bachelor’s or Master’s degree in Behavioral Health, Psychology, Social Work, or related field (or equivalent experience) and the following: Board Certified Behavior Analyst (BCBA) preferred or Registered Behavior Technician (RBT) Minimum 2–3 years of experience in Applied Behavior Analysis (ABA) Experience in clinical case review, peer review, quality assurance, or case management strongly preferred Solid understanding of ABA principles, clinical practices, and therapeutic techniques Knowledge of insurance requirements, medical necessity criteria, and healthcare documentation standards Familiarity with ABA guidelines and placement criteria for care advocacy Proficient in interpreting and communicating medical necessities using clinical terminology Strong analytical, organizational, and problem-solving skills Effective communication skills for collaboration with clinical teams, families, and external stakeholders Adherence to HIPAA and all applicable compliance standards Outstanding Benefits 21 paid days off (15 PTO days, increasing with tenure, plus 6 holidays) Flexible Spending Account (FSA) and Health Savings Account (HSA) options Medical, dental, vision, long-term disability, and life insurance Generous 401(k) with up to 6% employer match About Exact Billing Solutions Exact Billing Solutions is committed to building a culture of professionalism, accountability, and operational excellence. We believe billing is more than a back-office function—it’s a vital part of delivering quality healthcare. By hiring individuals with the right blend of expertise, integrity, and client focus, we empower providers to thrive while making the business of healthcare more efficient and sustainable. Join our mission and help transform healthcare billing with precision and purpose!

Responsibilities

The Clinical Support Specialist is responsible for assessing clinical documentation and treatment plans to ensure appropriate utilization of healthcare services. This role involves collaborating with clinical and administrative teams to enhance overall healthcare efficiency.