Billing Specialist - Patient Accounts

Position Overview

We are seeking a compassionate and detail-oriented Billing Specialist to join our team. This role focuses on patient responsibility collections while supporting families throughout their ABA journey.

Required Experience & Essential Skills

• 1-3 years of experience in healthcare billing/collections, health insurance interactions, or patient financial services
• Experience with insurance verification, claims processing, and accounts receivable
• Knowledge of healthcare billing regulations and HIPAA compliance requirements
• Strong customer service background with experience in sensitive financial conversations
• Excellent communication skills, both written and verbal
• Ability to resolve complex roadblocks independently and maintain diligent follow-up processes
• Willingness to go above and beyond to connect families with resources and help them navigate payment for services
• Familiarity with ABA Services preferred (CPT Codes 97151-97158) and Medicaid eligibility
• Familiarity with EHR systems (CentralReach preferred), and Microsoft Office Suite (Excel, Word, Outlook)
• Detail-oriented with strong organizational and time management skills
• Ability to work independently and manage multiple priorities in a fast-paced environment
• Familiarity working with both commercial insurance and government-funded (i.e., Medicaid and TRICARE) healthcare payors
• Demonstrated experience driving payor accountability - comfortable pushing on payors and advocating for insurance coverage and timely claims payment on behalf of clients
• Experience working with families or in pediatric, third-party reimbursed healthcare settings preferred

Benefits & Eligibility Checks

• Primary point of contact, managing relationship with third-party automated insurance verification partner
• Manage our automated insurance verification process using our third-party benefits verification platform for all new intake clients and ongoing verification for existing clients
• Review monthly eligibility checks to ensure continuous coverage and proactively identify policy changes
• Determine and communicate to families applicable ABA coverage limits and exclusions, deductibles, copayments, and authorization requirements
• Provide clear, understandable explanations to families about their insurance benefits, coverage details, and anticipated out-of-pocket costs based on verification results
• Maintain accurate and up-to-date insurance information in patient records and promptly update any changes identified
• Identify potential coverage gaps through platform reporting and work with families to secure alternative funding sources before service interruption
• Troubleshoot any platform issues and escalate complex verification cases to vendor support when needed

Claims Reprocessing & Appeals

• Reprocess insurance claims when patient financial obligations have been incorrectly calculated or applied by insurance carriers
• Prepare and file formal appeals for incorrectly denied claims, including compilation and submission of supporting clinical documentation
• Track appeal outcomes and follow up on pending decisions within established timeframes
• Maintain detailed logs of all reprocessing activities and communicate outcomes to relevant stakeholders

Payor Claims Enrollment (EFT & ERA enrollments)

• Complete Electronic Funds Transfer (EFT) enrollment applications for new insurance payors
• Set up Electronic Remittance Advice (ERA) enrollments to streamline payment processing and reconciliation
• Maintain current enrollment status for all active insurance contracts and renew as needed
• Proactively troubleshoot EFT and ERA processing issues and coordinate resolution with payor representatives
• Update banking and contact information for electronic payment systems as organizational changes occur