BILLING AND INSURANCE SPECIALIST
We are seeking an experienced, detail-oriented Billing and Insurance Specialist with a background in facility-based mental health and substance use disorder billing .
The ideal candidate will have hands-on experience with Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) billing and a solid understanding of the insurance claim and reimbursement process. Experience with out-of-network behavioral health billing and reimbursement is preferred.
This role combines medical billing, insurance reimbursement, patient account management, and financial operations. The Billing and Insurance Specialist will work closely with our insurance, finance, admissions, and clinical operations teams to ensure claims, insurance payments, patient payments, and account balances are processed and reconciled accurately.
This position reports directly to the Executive Director of Admissions and Insurance.
WHAT YOU’LL DO
Manage mental health billing. Assist with billing and claims for facility-based mental health and substance use disorder services, including PHP and IOP levels of care .
Process and review insurance claims. Ensure claims are submitted accurately and contain the appropriate patient, provider, facility, service, and billing information.
Work with out-of-network claims. Support the billing and reimbursement process for out-of-network insurance claims, including reviewing claim status, reimbursement, patient responsibility, and payment discrepancies.
Review EOBs and insurance reimbursement. Analyze Explanation of Benefits (EOBs), insurance payments, denials, adjustments, deductibles, coinsurance, and other claim determinations.
Post insurance payments. Accurately record detailed insurance payment and reimbursement information to patient accounts using our electronic billing software.
Research claim discrepancies. Identify and investigate unpaid, underpaid, denied, rejected, or incorrectly processed claims and assist with appropriate follow-up and resolution.
Support denials and appeals. Assist with claim follow-up, reconsiderations, appeals, and documentation when insurance claims are denied or incorrectly processed.
Respond to patient and guarantor questions. Professionally address questions regarding invoices, payments, insurance reimbursement, account balances, credits, and discrepancies.
Maintain accurate documentation. Scan, label, upload, and organize insurance correspondence, EOBs, checks, and other financial and billing documents in our electronic systems.
Collaborate across departments. Participate in regular meetings with finance, insurance, admissions, and other departments to review outstanding claims, patient balances, payments, reimbursement issues, and reconciliation matters.
REQUIRED EXPERIENCE AND QUALIFICATIONS
We are specifically seeking candidates with experience in medical billing and insurance reimbursement , preferably within a mental health and substance use disorder treatment setting.
The successful candidate should have:
Medical billing experience , with a strong understanding of the healthcare claim lifecycle from claim submission through adjudication and payment.
Experience with facility-based mental health and/or substance use disorder billing .
Working knowledge of PHP and IOP billing and reimbursement .
Working knowledge of Verification of Benefits, HCPCS codes, Revenue Codes, ICD10 Coding, UB04 claim forms, EOBs, deductibles, coinsurance, denials, adjustments, and appeals .
Experience reviewing insurance reimbursement and identifying claim payment or processing discrepancies.
Familiarity with HIPAA requirements and the handling of confidential patient and financial information.
Excellent written and verbal communication skills, including the ability to communicate professionally with patients, guarantors, insurance representatives, and colleagues.
Exceptional attention to detail and the ability to reconcile complex patient and insurance accounts.
Strong…