Medical Biller

In2Great Pediatric Therapy•Buffalo Grove, IL

2d•$60,000 - $65,000

About The Position

The Medical Biller will be responsible for a variety of tasks related to insurance billing, authorization requests, claims submission, and payment posting. This role requires a strong understanding of medical billing processes, insurance plan requirements, and revenue cycle management. The ideal candidate will have experience with ABA billing and pediatric therapy services, proficiency in practice management systems, and excellent communication and organizational skills.

Requirements

Minimum 3 to 5 years of medical billing, insurance authorization, or revenue cycle experience.
Proven experience managing insurance denials, appeals, and authorizations.
Proficiency with Central Reach or similar practice management systems.
Experience with insurance clearinghouses and claims management platforms.
Strong Microsoft 365 skills, including Excel, Outlook, Teams, and Word.
Knowledge of Medicaid, Medicare, BCBS, and commercial insurance plans.
Experience preparing authorization and claims appeals.
Ability to communicate effectively via phone, email, and virtual platforms.
Ability to manage detailed administrative work with a high level of accuracy.
Strong understanding of insurance billing processes, EOB interpretation, and revenue cycle management.
Familiarity with payer requirements, authorization procedures, and pediatric therapy reimbursement guidelines.
Excellent written and verbal communication skills.
Strong organizational and time management abilities.
Ability to manage multiple priorities while maintaining accuracy and compliance.
Demonstrated problem-solving and analytical skills.

Nice To Haves

Prior experience with ABA billing and pediatric therapy services in behavioral health strongly preferred.

Responsibilities

Submit ABA authorization requests and extension requests to insurance companies.
Follow up with insurance case coordinators regarding pending authorization requests.
Audit clinical packets, supporting documentation, and assessments required for authorization approvals.
Track authorization due dates and renewal timelines using Monday.com and other tracking systems.
Support the development and submission of authorization appeals when services are denied or reduced.
Review, scrub, and submit electronic and paper claims for ABA and therapy services.
Research and resolve claim rejections, denials, and payment delays.
Investigate payer-specific billing issues and implement corrective actions.
Manage claim aging reports and follow up on outstanding accounts receivable balances for all disciplines.
Write and submit claims appealing to recover denied reimbursement.
Verify insurance eligibility, benefits, authorizations, and coverage requirements, primarily for ABA services.
Document benefit information, authorization requirements, and payer communications in Central Reach.
Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
Post payments accurately and reconcile insurance payments.
Identify denial trends and develop action plans for resolution.
Complete Work-In-Progress (WIP) documentation by recording ERA dates, payment amounts, adjustments, and write-offs.
Process and monitor secondary insurance billing for all disciplines.
Track recoupments and overpayment requests received by mail and electronically, ensuring validity before repayment.
Maintain detailed documentation of insurance calls, payer correspondence, and critical communications within Central Reach.
Respond promptly to Teams messages, emails, and internal requests.
Open and review insurance correspondence, identifying denials, requests for records, and reimbursement issues.
Collaborate with clinical, scheduling, and leadership teams to resolve billing and authorization concerns.
Monitor clean claim ratios and claim generation accuracy.
Recommend process improvements to enhance reimbursement rates and operational efficiency.