Billing Specialist

Wayside Youth & Family Support Network•Framingham, MA

11d•$22 - $29•Hybrid

About The Position

Wayside Youth and Family Support Network is looking for a highly organized detail oriented Billing Specialist to manage billing operations for children’s behavioral health services. The Billing Specialist reports to the Director of Revenue and is responsible for full-cycle medical billing, including claim submission, claim denials, payment posting, and accounts receivable oversight. The individual in this role will ensure accurate and timely reimbursement, maintain clean accounts receivable (AR) balances, monitor claim trends, and ensure compliance with agency and payer requirements, including MassHealth, Medicaid, and commercial insurers. The Billing Specialist will develop a comprehensive understanding of billing regulations and payer guidelines, resolve complex claims issues, and provide accurate financial data to program directors and senior staff on an ongoing basis. This position requires proactive problem-solving, high attention to detail, the ability to work independently or cross functionally with clinical, administrative, and finance teams. The candidate must have strong communication and collaboration skills and will be accountable for following through on matters to ensure timely resolution.

Requirements

Associate’s or bachelor’s degree in healthcare administration, finance, business, or related field (or equivalent experience).
4+ years of experience in medical billing or revenue cycle management, including third-party billing, preferably in behavioral or mental health.
Strong knowledge of payer requirements (MassHealth/Medicaid, commercial insurers, COB) and claims lifecycle management (submissions, denials, appeals, reimbursement).

Nice To Haves

Experience with Qualifacts Carelogic and Inovalon clearinghouse systems preferred, with the ability to apply system functionality for accurate claims management and reporting

Responsibilities

Perform full-cycle billing functions for children’s behavioral health services, managing complex claims with a high level of accuracy and efficiency.
Manage the daily submission of high-volume primary and secondary claims, ensuring compliance with payer requirements.
Verify and validate all claim data, including provider information, member eligibility, filing limits, and coding for HCPCS, CPT, diagnoses, and procedures.
Effectively validate claim acceptance to ensure successful submission and timely reimbursement.
Apply in-depth knowledge of payer requirements, including MassHealth/Medicaid, commercial insurers, and coordination of benefits (COB).
Proactively manage denied and rejected claims by researching, reviewing, correcting, and appealing complex or escalated issues to ensure timely resolution.
Prevent recurring errors and maintain clear communication with insurance companies and families throughout the resolution process.
Utilize billing systems, including EDI, clearinghouses, CMS-1500/UB forms, and EHR platforms, to ensure accurate claim submission and tracking.
Monitor billing workflows for problems, such as claims not processing correctly or a high volume of outstanding accounts receivable and take appropriate corrective action.
Generate client statements, conduct collection follow-ups, and process invoices as needed to maintain clean accounts receivable balances.
Collaborate with internal teams to resolve billing discrepancies and improve claim accuracy at the source, supporting workflow efficiency and process improvement initiatives.
Support other billing and revenue cycle tasks as assigned, contributing to overall organizational financial performance.