Job Description

Task Summary

The Billing Specialist is responsible for accurately preparing, submitting, and following up on claims to ensure timely and complete payment. This role is focused on billing and claims processing activities for Medicaid, Medicare, MCOs, and other third-party payers. The Billing Specialist supports the agency’s financial operations by ensuring compliance with payer requirements, reducing denials, and maintaining accurate billing records.

Job Responsibilities

Primary Duties

• Prepare and submit facility and professional service claims to Medicaid, MCOs, and third-party payers in a timely and accurate manner.
• Review claims for completeness and accuracy prior to submission to minimize denials.
• Track claim status and follow up on unpaid or denied claims to ensure resolution and payment.
• Process claims corrections, resubmissions, and adjustments as needed.
• Post payments and reconcile accounts to confirm accurate allocation of reimbursements.
• Maintain organized billing records and generate reports related to billing and collections.
• Communicate with payers regarding claim status, denials, and required documentation.
• Work with clinical managers and staff to verify authorizations and confirm services are billable.
• Provide guidance to staff on billing-related questions as needed.
• Escalate unresolved claim or billing issues to the COO.
• Demonstrate adherence to the agency’s mission, policies, confidentiality standards, and code of ethics.
• Perform other billing-related duties as assigned to support timely claims processing.

Job Specifications

Education

• High school diploma or equivalent with coursework in math, bookkeeping, or business.
• Post-secondary courses in insurance billing, data processing, or medical terminology preferred.

Training and Experience

• Minimum three years of experience in medical billing or claims processing, preferably for facility and professional services.
• Medical coding certification, with emphasis on behavioral health care, preferred.

Knowledge and Skills

• Strong understanding of third-party billing requirements, particularly for behavioral health services.
• Proficiency with both paper and electronic claim submissions.
• Ability to work effectively with insurance companies, staff, and patients’ families.
• Excellent verbal and written communication skills.
• Highly detail-oriented with strong organizational and follow-up abilities.

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