Billing Specialist

ELS FOR AUTISM FOUNDATION•Jupiter, FL

19d

About The Position

The Billing Specialist supports the organization’s revenue cycle by coordinating with an outsourced medical billing company to ensure accurate and timely insurance claim processing, payment posting, and reconciliation of reimbursements to Explanation of Benefits (EOBs). The role maintains electronic medical billing records, manages client intake and onboarding in the electronic medical record system, and supports insurance billing and collections. The Billing Specialist monitors denied, rejected, unpaid, and underpaid claims across multiple insurance carriers and works with the billing company, clinical staff, program staff, and clients to address issues and support reimbursement. The position manages client account collections, including generating statements, following up on balances, establishing payment arrangements, and responding to billing inquiries. It also supports private-pay and third-party billing, verifies insurance benefits and authorizations, maintains accurate client and insurance information, and helps ensure compliance with payer and organizational requirements.

Requirements

High school diploma or equivalent required.
At least 2 years of experience in medical billing, healthcare revenue cycle management, insurance verification, or accounts receivable.
Experience working with commercial insurance, Medicaid, managed care plans, and private-pay billing.
Knowledge of medical billing processes, including claim submission, payment posting, authorizations, denials, appeals, and insurance eligibility verification.
Understanding of healthcare insurance terminology, including deductibles, copayments, coinsurance, coordination of benefits, authorizations, and EOBs.
Experience with an electronic health record (EHR) or practice management system.
Proficiency in Microsoft Office Suite, including Outlook, Excel, Word, and Teams.
Ability to maintain confidentiality and handle protected health information (PHI) in accordance with HIPAA regulations.
Strong attention to detail and accuracy in data entry and billing processes.
Ability to analyze and resolve billing discrepancies, claim denials, and authorization issues.
Effective collaboration with clients, insurance companies, billing vendors, clinical staff, and internal departments.
Problem-solving and critical-thinking skills, including the ability to identify process improvements.
Ability to work independently while maintaining accountability.
Professionalism, discretion, and sensitivity when discussing insurance coverage, balances, and financial responsibilities with clients.

Nice To Haves

Associate’s degree in Business Administration, Healthcare Administration, Accounting, Finance, or a related field.
Experience with electronic health record and practice management systems, preferably Central Reach; Central Reach experience is strongly preferred.
Experience in ABA, behavioral health, therapy services, pediatric healthcare, or nonprofit healthcare environments.
Experience with insurance credentialing and provider enrollment processes.
Knowledge of revenue cycle management best practices and insurance reimbursement processes.
Experience reconciling accounts receivable and processing client payments.
Familiarity with QuickBooks, accounting systems, or financial reconciliation processes.
Strong organizational skills and the ability to manage multiple priorities.
Excellent customer service and communication skills when interacting with clients, insurance companies, and internal staff.

Responsibilities

Record and reconcile accounts receivable transactions across multiple payment platforms and merchants.
Assist with private-pay billing for program services, including GOALS, therapeutic services, recreation therapy, and other program-related services.
Process client payments and maintain accurate payment records.
Research and resolve payment discrepancies, billing inquiries, and account balances.
Collaborate with Program Directors, Clinical Staff, and the Controller to support accurate billing and revenue recognition.
Support month-end billing and accounts receivable reconciliation.
Act as a liaison among clients, the medical billing company, clinical providers, and program staff on billing matters, including claim denials, authorization expirations, billing issues, and payment questions.
Verify insurance eligibility and benefits before services begin and when coverage changes.
Coordinate with the medical billing company on claim submission, tracking, denial management, and resubmissions.
Monitor outstanding claims and assist with resolving denied, rejected, or underpaid claims.
Respond to client questions about insurance billing, benefits, claims, patient responsibility, deductibles, copayments, coinsurance, and payment arrangements.
Maintain accurate insurance information and client billing records in accordance with organizational policies and payer requirements.
Assist with insurance credentialing and recredentialing activities as assigned.
Monitor insurance authorization status for clients and services in Central Reach to support uninterrupted service delivery.
Identify and correct authorization discrepancies, data-entry errors, and billing issues, or escalate concerns as needed.
Manage Central Reach intake and onboarding for new clients and staff.
Create and maintain client authorizations, staff assignments, and service connections in Central Reach.
Update and maintain insurance fee schedules, payer rates, and billing information in Central Reach.
Keep client demographic, insurance, and authorization information accurate and current.
Monitor and coordinate the annual Continuation of Services Consent process and ensure required documentation is completed and maintained on time.
Protect confidential client, financial, and insurance information in accordance with HIPAA and organizational privacy policies.
Ensure billing and documentation comply with payer regulations, contractual requirements, and organizational policies.
Maintain organized billing records and documentation for audits, payer reviews, and internal reporting.
Assist with special projects, process improvements, reporting, and other duties as assigned.