Role Description
The Billing Specialist supports Revenue Operations by managing medical billing processes, including:
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Coding
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Payment posting
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Accounts receivable aging
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Denial follow-up
This role ensures accurate and timely processing of claims and payments across Electronic Health Records (EHR) and Practice Management Systems (PMS).
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Billing and management of claims for multiple programs and payers to achieve maximum reimbursement
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Maintain working knowledge of multi-state payer rules, including Medicaid/MCOs, commercial insurance, third-party liability, state contracts, grants, and inter-organizational billing requirements
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Ensure claims are submitted timely and in compliance with payer requirements; review remittance advice to identify underpayments or discrepancies
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Reduce rejections and denials by scrubbing claims for timely and accurate submission
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Manage the resolution of insurance claim denials through detailed review, correction, and resubmission to optimize revenue recovery
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Collaborate with internal teams to resolve billing issues and improve workflows
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Manage aging accounts by contacting commercial payers and state programs to ensure timely and accurate payment
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Monitor aging reports to prioritize follow-up efforts
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Identify, verify, and submit claims to secondary and tertiary insurance carriers to maximize reimbursement
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Accurately post insurance and patient payments into Practice Management Systems (PMS)
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Prepare and maintain Excel worksheets, tracking tools, and ad hoc reports to support revenue cycle operations
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Prepare, or assist in the preparation of, financial reports, analyses, and special projects as needed
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Conduct follow-up with payers to resolve denials, rejections, and unpaid claims
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Maintain and manage Billing workflows across assigned programs to ensure efficient and consistent operations
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Review accounts to determine if adjustments are necessary
Qualifications
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High School diploma or equivalent
Requirements
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Minimum of two years of billing experience in a healthcare setting, behavioral health preferred
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Must be 21 years of age
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Must have a valid Driverβs License
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Must pass a drug screen, MVR, and Child Abuse and Neglect Central Registry clearance check
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Lifting Requirements of 30-50 lbs