Description and Purpose:
The Billing Specialist is responsible for managing all aspects of the billing, claims, and revenue cycle management processes within the behavioral health setting. This role ensures accurate and timely submission of claims, payment posting, account reconciliation, and follow-up on denied claims. Billing Specialist must have strong working knowledge of Medicare, Medicaid, and commercial insurance billing rules, as well as experience in working with CPT/HCPCS coding. The ideal candidate is detail-oriented, organized, and able to work independently. Billing Specialist will also cross train to provide occasional coverage support for front lobby reception desk.
Qualifications:
- Bachelor degree in related field is preferred
- At least two (2) years of insurance billing and claims management experience working within Electronic Medical Records (EMR) Systems; behavioral health billing experience a plus.
- Working knowledge of Medicare and Medicaid billing rules and regulations
- Familiarity with CPT, ICD-10, and HCPCS coding for behavioral health services strongly preferred
- Proficiency in Microsoft Office Suite (especially Excel) is preferred
- Strong communication, organization, and time management skills
- Ability to manage and prioritize multiple tasks and problem-solve independently
Patient Account Representative Duties and Responsibilities:
- Responsible for all billing workflow duties, including but not limited to: pre-billing reviews, batch and send out claims, manage payments and Explanation of Benefits (EOB), resolve claim denial issues, record adjustments and write-offs, and maintain accuracy in patient data and balances.
- Assists in monthly reconciliation of insurance and patient payments
- Manage denied claims, handle claim appeals and resubmissions, and resolve unpaid claims with insurance companies and patients
- Handles patient inquiries regarding billing and charges
- Manage patient accounts and patient payments and send out collection letters
- Assist with revenue cycle management, insurance contractual obligation issues, medical record reviews, and facility/provider credentialing as needed
- Support Admission functions and provide occasional front desk coverage
- Other duties as assigned
