Claims Resolution Specialist

ICBD • Fort Lauderdale, FL

12d

About The Position

Are you an experienced behavioral health collections professional ready to take your career to the next level with a growing, fast-moving company? You could be our Claims Resolution Specialist—Behavioral Health, responsible for effective communication and coordination with insurance companies and clients to obtain the maximum benefits for clients. We work with multiple expanding clinic locations, so timely collections are critical to our operations. The work you will do can make a real difference in the lives of client families and kids by allowing our partners to open clinics where they are desperately needed.

Requirements

• Behavioral health out-of-network billing: 3 years of experience
• Knowledge and experience with CollaborateMD EMR and billing software programs
• Claims denial experience with follow up from payers including appeals

Nice To Haves

• Associate's degree (preferred)
• Experience with ABA therapy preferred
• Experience/knowledge with CPT and ICD10 codes preferred

Responsibilities

• Review and manage assigned AR inventory to ensure timely follow-up on outstanding claims.
• Investigate and resolve denials, rejections, and underpayments by working directly with payors, and internal teams.
• Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.
• Document all collection activities clearly and accurately within our systems.
• Monitor payor trends and escalate recurring issues to leadership.
• Meet or exceed daily, weekly, and monthly productivity and quality standards.
• Support special projects and process improvement initiatives as assigned.
• Maintain effective communication with third-party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction
• Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc.
• Status claims and add notes in the patient accounting system (CollaborateMD)
• Escalate any payor or client claim issues to department leadership
• Establish/maintain effective communications with the leadership team to ensure that all third-party guidelines are satisfied
• Update patient demographics and insurance information as needed
• Ability to meet KPI established metrics for productivity

Benefits

• 21 paid days off (15 days of PTO, which increases with tenure, plus 6 holidays).
• Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
• Medical, dental, vision, long-term disability, and life insurance.
• Generous 401(k) with up to 6% employer match.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 501-1,000 employees