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A Billing and Payment Specialist is responsible for managing the financial aspects of treatment. Your main role is to ensure that all necessary billing information is accurately entered into the system, that insurance claims are properly filed.

• Insurance Claims Processing
• Accurately submit insurance claims using diagnostic and procedural codes (ICD-10, CPT/HCPCS).
• Identify and bill secondary and tertiary insurances where applicable.
• Follow up on rejected or denied claims, ensuring all necessary corrections are made, and resubmitting claims in a timely manner.
• Payment Posting and Reconciliation:
• Post payments received from patients, insurance companies, and third-party payers (including EFT, check, credit card, and ACH payments).
• Reconcile posted payments to ensure that actual payments match expected amounts, investigating and resolving discrepancies.
• Maintain accurate records of all financial transactions and regularly provide reports to management.
• Patient Communication and Collections:
• Communicate with patients regarding their financial obligations, explaining billing statements, insurance correspondence, and payment options.
• Follow up with patients and insurance companies on overdue balances and coordinate payment arrangements as necessary.
• Manage collections activities by working closely with insurance companies to collect outstanding balances for substance use disorder and other healthcare services.
• Compliance and Industry Knowledge:
• Stay updated on changes in healthcare regulations, insurance guidelines (HMO/PPO, Medicare, Medicaid), and billing practices.
• Ensure adherence to HIPAA and other privacy laws when handling patient financial information.

Experience: 3+ years of billing, payment posting, and claims collection experience, preferably in the healthcare sector (substance use disorder or mental health services).

Experience on Revenue Cycle Management (RCM) is an advantage.

Technical Skills: Proficiency in healthcare billing systems such as KIPU, CollaborateMD, and familiarity with insurance portals.

Organizational Skills: Strong multitasking ability and attention to detail, especially in managing multiple claims, payments, and billing activities simultaneously.

Communication Skills: Excellent verbal and written communication skills to interact with patients, insurance companies, and team members.

Problem-Solving: Strong analytical skills for resolving discrepancies in claims or payments and addressing denied claims.