Medical Biller / Insurance & Revenue Cycle SpecialistPosition Summary
The Medical Biller is responsible for managing the revenue cycle for The Integrated Life, ensuring timely and accurate claim submission, payment posting, insurance follow-up, and resolution of billing issues. This position requires a thorough understanding of behavioral health billing, commercial insurance, Medicare, MaineCare/Medicaid, and the complexities of insurance reimbursement.
The ideal candidate is highly organized, detail-oriented, self-motivated, and able to work independently while providing exceptional customer service to clients, staff, and insurance representatives. This individual serves as a knowledgeable resource regarding insurance benefits, billing questions, and reimbursement processes while maintaining professionalism, confidentiality, and accuracy.
Essential Duties and ResponsibilitiesInsurance & Claims Management
- Submit clean and accurate insurance claims in a timely manner.
- Monitor claims through the entire revenue cycle, from submission through payment or resolution.
- Review and correct rejected and denied claims, identifying trends and implementing corrective action.
- Follow up with commercial insurance companies, Medicare, and MaineCare/Medicaid regarding outstanding claims.
- Prepare and submit claim reconsiderations, corrected claims, and appeals when appropriate.
- Track claim aging and maintain established accounts receivable goals.
- Post insurance payments, adjustments, write-offs, and patient payments accurately.
- Reconcile billing discrepancies and investigate payment issues.
Insurance Knowledge
- Maintain a strong working knowledge of:
- Commercial insurance plans
- Medicare
- MaineCare/Medicaid
- Coordination of Benefits (COB)
- Prior authorizations
- Referrals
- Deductibles
- Copayments
- Coinsurance
- Out-of-pocket maximums
- Medical necessity requirements
- Credentialing implications affecting reimbursement
- Verify insurance eligibility and benefits when necessary.
- Understand payer-specific billing requirements and remain current with policy changes.
Client & Staff Support
- Professionally answer billing and insurance questions from clients with empathy, patience, and respect.
- Explain insurance benefits, patient financial responsibility, and billing statements in an understandable manner.
- Respond promptly to inquiries from clinicians and administrative staff regarding billing concerns.
- Research questions thoroughly when answers are not immediately known and ensure timely follow-up.
- Maintain positive and solution-focused communication in all interactions.
Revenue Cycle Management
- Monitor outstanding balances and accounts receivable.
- Identify opportunities to improve billing accuracy and reimbursement efficiency.
- Maintain accurate financial records within the electronic health record (EHR) and billing systems.
- Assist with month-end reporting and reconciliation as requested.
- Support audits and maintain documentation required for compliance.
Compliance
- Maintain compliance with HIPAA and all applicable federal and state regulations.
- Follow payer guidelines and behavioral health billing requirements.
- Maintain confidentiality of all client and agency information.
- Stay informed regarding changes in insurance regulations and reimbursement policies.
QualificationsRequired
- High school diploma or equivalent.
- Minimum of two years of medical billing experience (behavioral health preferred).
- Demonstrated knowledge of commercial insurance, Medicare, and MaineCare/Medicaid billing.
- Experience working with insurance denials, appeals, and claims follow-up.
- Strong computer skills and ability to learn electronic health record and billing software.
- Excellent written and verbal communication skills.
- Strong organizational skills with exceptional attention to detail.
- Ability to prioritize multiple tasks and meet deadlines.
- Ability to work independently with minimal supervision.
- Commitment to providing outstanding customer service.
Preferred
- Experience billing for outpatient behavioral health services.
- Knowledge of CPT, ICD-10, and behavioral health documentation requirements.
- Familiarity with electronic clearinghouses and practice management software.
- Experience with credentialing processes is a plus.
Core Competencies
The ideal candidate will demonstrate:
- Exceptional attention to detail
- Strong analytical and problem-solving skills
- Professionalism and integrity
- Reliability and accountability
- Excellent customer service
- Strong organizational abilities
- Effective written and verbal communication
- Initiative and independent decision-making
- Ability to navigate complex insurance systems
- Adaptability in a fast-paced healthcare environment
- Commitment to continuous learning
Physical Requirements
- Prolonged periods of sitting and computer work.
- Ability to communicate effectively by telephone, email, and in person.
The Integrated Life Values
Employees of The Integrated Life are expected to embody our commitment to compassionate, trauma-informed, culturally responsive, and person-centered care. We value integrity, collaboration, accountability, continuous learning, and a commitment to improving access to quality mental health services for our community.
This position plays a critical role in ensuring that our clients can access care while supporting the financial sustainability of the agency through accurate, ethical, and efficient billing practices.
Pay: $53,235.91 - $64,112.06 per year
Benefits:
- Flexible schedule
- Health insurance
- Health savings account
- Paid time off
Work Location: Remote
