Administrative & Medical Billing Specialist

PEDIATRIC SPEECH LAB LLC•Waldorf, MD

11d•$23 - $25•Onsite

About The Position

Pediatric Speech Lab (PSL) is seeking a highly organized, dependable, and proactive Administrative & Medical Billing Specialist to support the administrative, billing, insurance, and operational functions of our growing ABA and pediatric speech therapy programs. This in-clinic position combines administrative and clinical duties, designed for someone with strong administrative and medical billing skills. The ideal candidate will have experience with medical billing, insurance claims, authorizations, accounts receivable, scheduling, and healthcare administration, preferably within ABA, speech therapy, pediatric, rehabilitative, or habilitative healthcare settings. This is not an entry-level billing position. The successful candidate should be able to work independently, identify billing and authorization issues, follow outstanding claims through resolution, and communicate effectively with leadership, insurance companies, families, and clinical staff. The position requires the ability to transition between administrative and billing responsibilities.

Requirements

High school diploma or equivalent required.
Professional medical billing experience required.
Experience with ABA, Speech Therapy, rehabilitative, habilitative, pediatric, or other therapy-based healthcare billing strongly preferred.
Experience with Medicaid and commercial insurance.
Experience with insurance verification and eligibility.
Experience obtaining and managing prior authorizations.
Experience with denial management and appeals.
Experience reviewing EOBs and ERAs.
Experience working accounts receivable and aging claims.
Experience submitting corrected claims and claim resubmissions.
Experience with medical records and electronic billing systems.
Minimum of 2 years of administrative experience preferred, including scheduling, phones, documentation, or similar responsibilities.
Experience working in a medical office, pediatric setting, ABA clinic, or rehabilitative healthcare environment highly preferred.
Experience with Motivity or similar clinical/EHR software preferred.
Strong computer skills, including Microsoft Office and Adobe.
Excellent written and verbal communication skills.
Strong organizational and time-management abilities.
Ability to multitask and prioritize in a fast-paced environment.
Ability to work independently and take ownership of assigned responsibilities.
Organized, dependable, and detail-oriented
Experienced in medical billing and healthcare administration
Comfortable working with insurance companies and payer requirements
Knowledgeable about ABA and/or therapy-based healthcare billing
Compassionate and comfortable working with children and families
A strong communicator and team player
Flexible and able to adapt to changing schedules and priorities
Proactive and comfortable working independently
Resourceful and solution-oriented
Coachable and eager to learn
Professional and committed to maintaining confidentiality
Comfortable transitioning between administrative and clinical responsibilities
Able to prioritize competing deadlines and responsibilities

Nice To Haves

Experience with ABA, Speech Therapy, rehabilitative, habilitative, pediatric, or other therapy-based healthcare billing strongly preferred.
Minimum of 2 years of administrative experience preferred, including scheduling, phones, documentation, or similar responsibilities.
Experience working in a medical office, pediatric setting, ABA clinic, or rehabilitative healthcare environment highly preferred.
Experience with Motivity or similar clinical/EHR software preferred.

Responsibilities

Submit accurate and timely claims for ABA and Speech Therapy services.
Verify insurance eligibility, benefits, coverage requirements, and authorization requirements.
Review claims for accurate CPT/HCPCS codes, units, provider information, and authorization requirements.
Monitor claim status and follow claims through payment or resolution.
Review EOBs and ERAs and identify payment discrepancies.
Work denied, rejected, underpaid, and outstanding claims.
Submit corrected claims, reconsiderations, appeals, and supporting documentation when necessary.
Monitor accounts receivable and aging reports and actively work outstanding balances.
Identify trends in denials, rejected claims, and billing errors.
Communicate billing concerns and trends to leadership.
Reconcile services rendered, clinical documentation, authorizations, and claims to identify missing or incorrect billing.
Monitor timely filing requirements and payer-specific billing guidelines.
Identify billing issues related to provider enrollment, credentialing, authorization, eligibility, or documentation.
Communicate with insurance companies regarding claim status, denials, authorizations, and reimbursement issues.
Maintain accurate billing records and supporting documentation.
Assist with billing-related questions from families and staff.
Research payer requirements and assist leadership in resolving recurring reimbursement issues.
Track ABA and Speech Therapy insurance authorizations.
Obtain and maintain required authorizations.
Monitor authorization expiration dates and initiate renewals before services are interrupted.
Verify insurance eligibility and benefits.
Communicate with insurance companies regarding authorization and coverage requirements.
Maintain accurate authorization records.
Identify potential authorization issues that could result in non-payment.
Communicate authorization concerns to clinical and administrative leadership.
Create, maintain, and adjust ABA therapy schedules for clients and therapists.
Coordinate therapist availability and ensure appropriate coverage.
Manage schedule changes related to cancellations, staffing, and client needs.
Communicate schedule changes promptly to staff and families.
Assist with maintaining accurate client and provider schedules.
Identify scheduling issues that may affect authorized services or reimbursement.
Assist with onboarding new clients and creating client profiles.
Collect and maintain required intake and insurance documentation.
Serve as a professional point of contact for parents and caregivers regarding scheduling, administrative questions, and billing matters.
Communicate appointment confirmations, cancellations, rescheduling, and general clinic announcements.
Assist families with billing-related questions and direct more complex concerns to leadership when appropriate.
Provide professional, compassionate, and responsive customer service.
Enter and update patient information accurately in the electronic health record system.
Maintain complete and organized client documentation.
Reconcile clinical documentation with billing requirements when necessary.
Ensure required billing and authorization documentation is maintained.
Utilize clinic management and EHR systems, including Motivity when applicable.
Maintain HIPAA compliance and confidentiality at all times.
Assist with daily administrative operations.
Assist with opening and closing procedures as assigned.
Maintain an organized and professional administrative area.
Distribute clinic-wide announcements and internal communications.
Conduct research related to insurance requirements, ABA processes, billing requirements, and operational improvements.
Assist leadership with administrative tasks and special projects.
Participate in staff meetings, training, and professional development.
Identify operational issues that may affect scheduling, documentation, billing, or reimbursement.