Billing Specialist (160)

About the role

Lifeworks is a nonprofit organization dedicated to providing advocacy, empowerment, and opportunity to adults with developmental and intellectual disabilities. As a member of our team, you'll play a crucial role in supporting our mission through your work in billing operations.

Responsibilities

• Review, research, and resolve denied or rejected insurance claims, prioritizing those nearing timely filing limits.
• Support billing operations for an outpatient mental health clinic serving individuals with intellectual and developmental disabilities.
• Verify insurance coverage for new referrals, focusing on Medicare, MassHealth/Medicaid, and other Massachusetts payer requirements.
• Confirm clinician eligibility, credentialing status, authorization requirements, and payer rules before client assignment or billing submission.
• Enter, update, and maintain accurate billing, demographic, authorization, and insurance information in Ehana.
• Run and monitor billing reports from Ehana, payers, clearinghouses, and other vendor systems to identify trends, errors, denials, and missed revenue opportunities.
• Collaborate with the billing department, Clinical Director, clinicians, administrative staff, and families when appropriate to clarify coverage, billing requirements, claim issues, and loss-of-coverage concerns.
• Aid in credentialing applications, payer enrollments, revalidations, and related follow-up needed to support clinic growth and provider participation.
• Help develop, document, and improve standard operating procedures for billing, insurance verification, claim follow-up, denial management, and payer communication.
• Provide billing-related training, guidance, and support to clinicians and program staff to promote accurate documentation, timely billing, and compliance with payer requirements.
• Participate in regular denial review and billing performance meetings to identify root causes, recommend process improvements, and track action plans.
• Work with leadership and billing partners to support scalable billing practices as the agency expands services, payer relationships, and outpatient clinic capacity.
• Maintain confidentiality and comply with all applicable Human Rights, DPPC, DDS, MassHealth/Medicaid, Medicare, payer, funding, HIPAA, and Lifeworks requirements.

Requirements

• High School Diploma or GED required; associate degree or coursework in accounting, business administration, healthcare administration, medical billing, or a related field preferred.
• Minimum of five years of related experience in billing, accounting, claims processing, revenue cycle, or healthcare administrative support required; experience in outpatient behavioral health or mental health billing strongly preferred.
• Working knowledge of Massachusetts insurance processes, including MassHealth/Medicaid, Medicare, managed care plans, eligibility verification, claim submission, denial follow-up, and timely filing requirements, preferred.
• Experience supporting billing functions in a clinical or human services setting serving individuals with intellectual and developmental disabilities is preferred.
• Strong computer skills required, including proficiency with Microsoft Office Suite, especially Excel, Word, and PowerPoint. Experience with spreadsheet tracking, database management, billing reports, and electronic health record or billing systems required.
• CPR, First Aid certification, Medical Administration.
• Must be able to pass Fingerprint background check, CORI, DPPC and Driving background checks.
• Valid Driver's License in the state residing.
• Excellent verbal and written communication skills.

Benefits

• Dental insurance
• 5 days of MA sick time

Pay

$27-$30/hr

Schedule

Part-time, flexible schedule