Medical Billing Specialist

The Medical Billing Specialist ensures individuals have the financial resources to access and maintain services. This role works directly with individuals, families, and third-party payers to determine eligibility, benefits, and payment options. The specialist helps remove financial barriers, explains insurance coverage and limits, and assists with financial assistance programs and paperwork. The role also proactively identifies financial issues and collaborates with Intake and Finance Departments to reduce roadblocks that could prevent or disrupt service delivery.

Key responsibilities

• Work with clients to resolve financial issues and provide exceptional customer service
• Notify clients of insurance lapses and non-covered services
• Secure benefits and financial assistance, and assist with paperwork
• Provide financial counseling and connect clients with community resources
• Oversee eligibility for sliding scale, grant-funded services, and scholarships
• Handle inquiries related to financial aid, billing disputes, prior authorizations, and payment plans
• Meet productivity, financial, and operational performance indicators
• Minimize lapses in insurance and payment disruptions
• Collect co-payments and document payments accurately
• Understand Medicaid and third-party payer regulations
• Use software to manage financial assistance data and run eligibility reports
• Ensure accurate and timely documentation
• Stay informed on funding changes and insurance coverage updates
• Verify insurance coverage and update billing systems
• Collaborate with Finance, Intake, and program staff to ensure continuity of care
• Build relationships with external partners to maximize financial assistance
• Assist with timely processing of behavioral health claims