Billing Specialist

Description

Full-Time Position

Pay Rate: $24.46 per hour

The Billing Specialist is responsible for supporting the organization's revenue cycle by working closely with the outsourced medical billing company to ensure accurate and timely processing of insurance claims, payment posting, and reconciliation of reimbursements to Explanation of Benefits (EOBs). This position maintains electronic medical billing records, manages client intake and onboarding activities within the electronic medical record system, and serves as a key resource for insurance billing and collections processes.

The Billing Specialist monitors and follows up on denied, rejected, and unpaid insurance claims across multiple insurance carriers, coordinating with the billing company, clinical staff, and clients to resolve issues and maximize reimbursement. This role is also responsible for managing patient account collections, including generating statements, contacting clients regarding outstanding balances, establishing payment arrangements, and responding to billing inquiries.

Additionally, the Billing Specialist assists with billing activities for both private-pay and third-party payors, verifies insurance benefits and authorizations, maintains accurate client and insurance information, and supports ongoing compliance with payer and organizational requirements. The ideal candidate possesses strong organizational skills, attention to detail, customer service abilities, and experience working with healthcare billing systems and insurance reimbursement processes.

Requirements

Accounts Receivable & Client Billing

• Record and reconcile accounts receivable transactions across multiple payment platforms and merchants.
• Assist with private pay billing for program services, including GOALS, therapeutic services, recreation therapy, and other program-related services.
• Process client payments and maintain accurate payment records.
• Research and resolve payment discrepancies, billing inquiries, and account balances.
• Work collaboratively with Program Directors, Clinical Staff, and the Controller to ensure accurate billing and revenue recognition.
• Support month-end billing and accounts receivable reconciliation processes.

 Insurance Billing & Revenue Cycle Management

• Serve as a liaison between clients, the medical billing company, clinical providers, and program staff regarding billing matters, including claim denials, authorization expirations, billing issues, and payment questions.
• Verify insurance eligibility and benefits prior to the initiation of services and as coverage changes occur.
• Work directly with the medical billing company to ensure accurate claim submission, claim tracking, denial management, and resubmissions.
• Monitor outstanding claims and assist in resolving denied, rejected, or underpaid claims.
• Respond to client inquiries regarding insurance billing, benefits, claims, patient responsibility, deductibles, copayments, coinsurance, and payment arrangements.
• Maintain accurate insurance information and client billing records in compliance with organizational policies and payer requirements.
• Assist with insurance credentialing and recredentialing activities as assigned.

Authorization & Central Reach Administration

• Monitor insurance authorization status for all clients and services within Central Reach to support uninterrupted service delivery.
• Identify authorization discrepancies, data entry errors, and billing issues and make appropriate corrections or escalate concerns as needed.
• Manage the Central Reach intake and onboarding process for new clients and staff.
• Create and maintain client authorizations, staff assignments, and service connections within Central Reach.
• Update and maintain insurance fee schedules, payer rates, and billing information in Central Reach.
• Ensure client demographic, insurance, and authorization information remains accurate and current.
• Monitor and coordinate the annual Continuation of Services Consent process and ensure required documentation is completed and maintained timely.

Compliance & Administrative Support

• Maintain confidentiality of client, financial, and insurance information in accordance with HIPAA and organizational privacy policies.
• Ensure billing and documentation practices comply with payer regulations, contractual requirements, and organizational policies.
• Maintain organized billing records and documentation to support audits, payer reviews, and internal reporting.
• Assist with special projects, process improvements, reporting, and other duties as assigned.

Preferred Knowledge, Skills & Abilities

• Experience working with electronic health record (EHR) and practice management systems, preferably Central Reach.
• Understanding of insurance terminology, including deductibles, copayments, coinsurance, authorizations, and claim denials.
• Strong attention to detail, organizational skills, and ability to manage multiple priorities.
• Excellent customer service and communication skills when interacting with clients, insurance companies, and internal staff.
• Proficiency in Microsoft Office Suite, including Excel, Outlook, Teams, and Word.

Required Qualifications

• High school diploma or equivalent required; Associate’s degree in Business Administration, Healthcare Administration, Accounting, Finance, or a related field preferred.
• Minimum of 2 years of experience in medical billing, healthcare revenue cycle management, insurance verification, or accounts receivable.
• Experience working with commercial insurance, Medicaid, managed care plans, and private pay billing.
• Knowledge of medical billing processes, claim submission, payment posting, authorizations, denials, appeals, and insurance eligibility verification.
• Understanding of healthcare insurance terminology, including deductibles, copayments, coinsurance, coordination of benefits, authorizations, and explanation of benefits (EOBs).
• Experience working with electronic health record (EHR) or practice management systems; Central Reach experience strongly preferred.
• Proficiency in Microsoft Office Suite, including Outlook, Excel, Word, and Teams.
• Ability to maintain confidentiality and handle protected health information (PHI) in accordance with HIPAA regulations.  

Preferred Qualifications

• Experience in ABA, behavioral health, therapy services, pediatric healthcare, or nonprofit healthcare environments.
• Experience with insurance credentialing and provider enrollment processes.
• Knowledge of revenue cycle management best practices and insurance reimbursement processes.
• Experience reconciling accounts receivable and processing client payments.
• Familiarity with QuickBooks, accounting systems, or financial reconciliation processes.

Required Skills and Competencies

• Strong attention to detail and accuracy in data entry and billing processes.
• Ability to analyze and resolve billing discrepancies, claim denials, and authorization issues.
• Effective collaboration with clients, insurance companies, billing vendors, clinical staff, and internal departments.
• Problem-solving and critical-thinking skills with the ability to identify process improvements.
• Ability to work independently while maintaining a high degree of accountability.
• Professionalism, discretion, and sensitivity when communicating with clients regarding insurance coverage, balances, and financial responsibilities.