Billing Specialist - IN PERSON

Northern Ohio Recovery Association•Cleveland, OH

11d•$40,000 - $50,000•Onsite

About The Position

The Billing Specialist supports NORA’s billing and revenue cycle operations by ensuring accurate claims submission, authorization management, reimbursement monitoring, Medicaid eligibility, accounts payable activities, and payer follow-up. The position works closely with clinical and administrative teams to support timely reimbursement, accurate documentation, and compliance with payer, regulatory, HIPAA, 42 CFR Part 2, and organizational requirements. This position is expected to model professionalism, recovery principles, and prosocial behavior in all interactions.

Requirements

Minimum two years of experience in behavioral healthcare, substance use disorder treatment, healthcare billing, utilization review, managed care, insurance authorization, case management, revenue cycle, or a closely related field.
Behavioral health and/or substance use disorder experience required.
Working knowledge of Medicaid billing and insurance authorization processes.
Knowledge of precertification, concurrent review, continued-stay review, authorization tracking, payer follow-up, and appeals.
Ability to interpret clinical documentation and communicate information related to symptoms, functional impairment, risk, treatment needs, progress, and barriers to discharge.
Strong attention to detail, organization, documentation, and follow-through.
Ability to manage multiple cases, deadlines, and competing priorities.
Strong written, verbal, communication, and problem-solving skills.
Proficiency with billing software, electronic medical records, Microsoft Office, and payer portals.
Working knowledge of HIPAA and 42 CFR Part 2.
Demonstrated commitment to confidentiality, professionalism, ethical conduct, and NORA’s mission.

Nice To Haves

Knowledge of ASAM Criteria and experience with residential, inpatient, partial hospitalization, intensive outpatient, and outpatient levels of care preferred.

Responsibilities

Submit and monitor claims accurately and timely; identify and resolve billing discrepancies and reimbursement issues.
Process and monitor accounts payable activities and complete required billing documentation and reports.
Verify Medicaid eligibility for outpatient clients and maintain accurate eligibility and billing records.
Manage payer authorizations across the continuum of care, including admissions, precertification, concurrent and continued-stay reviews, step-downs, and retrospective reviews.
Track authorization requirements, approved levels of care, units or days, effective and review dates, authorization numbers, and payer-specific conditions.
Review clinical documentation and collaborate with treatment teams to obtain information needed to support medical necessity and authorization requests without directing clinical care or altering the clinical record.
Communicate clinical information to payer representatives using applicable medical-necessity criteria and payer guidelines.
Monitor authorization deadlines and assigned cases, escalating unresolved documentation, payer, or authorization issues before reimbursement is placed at risk.
Identify documentation gaps, adverse determinations, and potential denials; coordinate peer-to-peer reviews, reconsideration's, appeals, and other payer escalation activities as assigned.
Prepare case summaries and supporting documentation for appeals, peer reviews, audits, and payer follow-up.
Review payer correspondence and adverse determinations, communicate outcomes to appropriate staff, and complete required follow-up within established deadlines.
Participate in denial review, quality audits, root-cause analysis, training, and performance-improvement activities.
Maintain working knowledge of payer requirements, authorization processes, medical-necessity criteria, and applicable regulatory standards.
Collaborate with Billing, Clinical, Compliance, Patient Financial Services, Utilization Review, Admissions, and other Revenue Cycle partners.
Maintain accurate records in the electronic medical record, payer portals, tracking systems, and other designated applications.
Protect client privacy and maintain compliance with HIPAA, 42 CFR Part 2, payer requirements, accreditation standards, and NORA policies.
Provide professional internal and external customer service and communicate effectively with clients, staff, payers, and regulatory entities.
Maintain compliance with NORA’s Code of Ethics and Policies and Procedures Manual.
Complete special projects and other duties as assigned.