The Billing Specialist supports the Revenue Cycle Department by managing a high volume of claims and maintaining a consistent workflow. This role may also serve as a primary subject matter resource for residential billing.
Key Responsibilities
- Generate insurance claims and collect outstanding insurance balances
- Prepare and submit accurate out-of-network claims for residential behavioral health services
- Submit appeals and reconsiderations to insurance companies
- Follow up with insurance companies regarding accounts with outstanding balances
- Maintain timely and systematic collection follow-up
- Investigate denied claims, verify information, and update the database
- Ensure medical records needed for billing are included in client charts and/or submitted
- Complete payer rejections in a timely manner according to department standards
- Identify, separate, and mail claims requiring paper submission
- Monitor provider enrollments to help ensure claims process correctly and reimbursements are timely
- Review, research, and amend correspondence and explanation of benefits, making appropriate account adjustments
- Identify and communicate system and reimbursement issues to support accurate payer review
- Meet billing compliance standards
- Contact insurance carriers to request claim reprocessing according to contracts and plan benefits
- Protect facility value by keeping collection information confidential
- Review billing reports and identify areas needing attention
- Provide follow-up updates to the supervisor from billing reports
- Assist other staff as needed to maintain productivity and efficiency
Working Conditions
- Office-based position in an air-conditioned, well-illuminated environment
- Fast-paced, high-workflow setting with frequent interaction
- May require flexible hours, including weekends, holidays, and evenings
- Participation in training, orientations, and compliance programs as needed
Requirements & Qualifications
Qualifications
- High school diploma or equivalent
- Billing and coding certification from one of the following:
- American Medical Billing Association (CRMS)
- AAPC: CPC, CPC-H/COC, CIC, or CPMA
- AHIMA: CCA, CCS, or CCS-P
- Minimum of 1 year of billing and coding experience
- Knowledge of CPT and ICD coding
- Strong computer skills, including Microsoft Office (Excel, Word, and PowerPoint)
- Experience using electronic health record software
- Excellent organizational, interpersonal, and communication skills
- Ability to manage multiple tasks, interruptions, and conflicting priorities
- Ability to work independently and under pressure
- Ability to read, write, and spell in English accurately
- Ability to lift up to 25 lbs and sit, stand, or walk for extended periods
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
1 week ago