Manage healthcare billing and revenue cycle activities, including claim submission, coding, payment posting, denial resolution, accounts receivable follow-up, and payer communication. Maintain compliance with multi-state payer requirements, monitor aging reports, submit secondary claims, prepare Excel tracking tools and financial reports, and improve billing workflows. The role requires at least two years of healthcare billing experience and involves behavioral health billing preferences.
Job Summary & Responsibilities
The Billing Specialist supports Revenue Operations by managing medical billing processes, including coding, payment posting, accounts receivable aging, and denial follow-up. This role ensures accurate and timely processing of claims and payments across Electronic Health Records (EHR) and Practice Management Systems (PMS).
- Billing and management of claims for multiple programs and payers to achieve maximum reimbursement
- Maintain working knowledge of multi-state payer rules, including Medicaid/MCOs, commercial insurance, third-party liability, state contracts, grants, and inter-organizational billing requirements
- Ensure claims are submitted timely and in compliance with payer requirements, reviews remittance advice to identify underpayments or discrepancies
- Reduce rejections and denials by scrubbing claims for timely and accurate submission
- Manages the resolution of insurance claim denials through detailed review, correction, and resubmission to optimize revenue recovery
- Collaborates with internal teams to resolve billing issues and improve workflows
- Manages aging accounts by contacting commercial payers and state programs to ensure timely and accurate payment
- Monitors aging reports to prioritize follow-up efforts
- Identifies, verifies, and submits claims to secondary and tertiary insurance carriers to maximize reimbursement
- Accurately posts insurance and patient payments into Practice Management Systems (PMS)
- Prepares and maintains Excel worksheets, tracking tools, and ad hoc reports to support revenue cycle operations
- Prepares, or assists in the preparation of, financial reports, analyses, and special projects as needed
- Conducts follow-up with payers to resolve denials, rejections, and unpaid claims
- Maintain and manage Billing workflows across assigned programs to ensure efficient and consistent operations
- Reviews accounts to determine if adjustments are necessary
- High School diploma or equivalent
MINIMUM EXPERIENCE & REQUIREMENTS:
- Minimum of two years of billing experience in a healthcare setting, behavioral health preferred
- Must be 21 years of age
- Must have a valid Driver’s License
- Must pass a drug screen, MVR, and Child Abuse and Neglect Central Registry clearance check
- Lifting Requirements of 30-50 lbs
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