Billing Specialist

This is a fully remote position, open to applicants in New York.

📋 Description

• Evaluate claims for precision and thoroughness before submission, encompassing patient demographics, insurance details, provider information, coding, modifiers, place of service, and other billing necessities.

• Submit pristine claims to commercial insurance, Medicare, Medicaid, and managed care payors.

• Track claim status and follow up on unpaid, underpaid, rejected, and denied claims.

• Investigate and resolve claim denials and rejections, including identifying root causes, making corrections, submitting reconsiderations or appeals, and monitoring claims until resolution.

• Manage accounts receivable and aging reports according to set follow-up timelines and priorities.

• Analyze payor remittances and Explanation of Benefits/Explanation of Payment documentation to uncover payment discrepancies, denials, recoupments, and related issues.

• Recognize underpayments and reimbursement discrepancies and escalate or pursue resolution as necessary.

• Correct and resubmit claims when billing errors or payor requirements become apparent.

• Engage with insurance companies regarding eligibility, claim status, authorizations, reimbursements, and other billing-related matters.

• Maintain comprehensive documentation of billing follow-up and actions taken.

• Identify recurring denial patterns, payor issues, or workflow challenges and report trends to Revenue Cycle leadership.

• Collaborate with clinical, operations, credentialing, and revenue cycle teams to resolve issues impacting claim submission or reimbursement.

• Keep an updated understanding of payor billing requirements and changes affecting reimbursement.

• Assist in billing-related audits, reconciliations, and other revenue cycle initiatives as required.

• Success is gauged by timely and accurate clean-claim submission, effective accounts receivable resolution, reduced denials, underpayment recovery, thorough documentation, independent issue resolution, and identification of process enhancements.

⛳️ Requirements

• Must be a permanent resident of the United States.

• At least 5 years of direct experience in medical billing and accounts receivable.

• Extensive experience managing claims throughout the complete billing lifecycle, from initial submission to final payment or resolution.

• Proficient in billing commercial insurance, Medicare, and Medicaid.

• Strong understanding of claim submission, rejection resolution, denial management, appeals, accounts receivable follow-up, and payor reimbursement.

• Familiarity with CPT, HCPCS, ICD-10-CM, modifiers, place-of-service requirements, and standard healthcare billing terminology.

• Experience utilizing payor portals, clearinghouses, and electronic health record/practice management systems.

• Ability to investigate complex billing issues and independently decide on appropriate subsequent actions.

• Exceptional attention to detail and capability to spot inconsistencies or errors that could affect reimbursement.

• Capacity to prioritize a high-volume workload and consistently follow claims to resolution.

• Strong written and verbal communication skills.

• Comfortable working independently in a remote, fast-paced environment.

• Willingness to accept and respond to constructive feedback.

• Passion for enhancing mental health care delivery.

• Preferably possess medical billing experience in behavioral health, psychiatry, or mental health services.

• Experience in billing psychotherapy, psychiatric evaluations, crisis services, and evaluation and management services is preferred.

• Previous work experience in a multi-state healthcare or telehealth organization is preferred.

• Experience with both fee-for-service Medicaid and Medicaid managed care is preferred.

• Familiarity with identifying denial trends and contributing to process improvements is preferred.

• CPC, CPB, or other relevant billing/coding certification is a plus but not mandatory if equivalent hands-on experience is present.

• Previous remote work experience is preferred.

🏝️ Benefits

• Paid time off (PTO) includes sick leave, specific federal holidays, and vacation.

• Wellness and Internet stipend.

• 401K plan.

• Medical, dental, and vision insurance.