Billing Specialist

Job Type

Full-time

Description

POSITION PURPOSE

The Billing Specialist is responsible for accurately preparing, submitting, and reconciling claims for all services provided across ACCESS programs. This position ensures compliance with payer requirements, resolves claim errors and denials, and maintains communication with insurance companies, Medicaid, and families to support timely reimbursement.

The Billing Specialist plays a critical role in maintaining the financial health of the organization by ensuring claims are submitted accurately, payments are received promptly, and billing processes operate efficiently and in accordance with applicable regulations, payer policies, and ACCESS standards.

ESSENTIAL FUNCTIONS & BASIC DUTIES

1. Prepares, reviews, and submits claims for all billable services in accordance with payer and ACCESS policies.

2. Verifies claim accuracy, ensuring correct CPT / HCPCS codes, modifiers, authorizations, and payer source alignment.

3. Monitors clearinghouse rejections and promptly corrects errors to prevent reimbursement delays.

4. Posts payments, adjustments, and denials accurately and timely.

5. Reconciles deposits with remittance advices and maintain complete records of all billing and payment activities for reporting and audit purposes.

6. Reviews and resolves denied, rejected, or partially paid claims by researching payer feedback, correcting errors, and submitting appeals or resubmissions as needed.

7. Tracks recurring issues and communicates patterns or payer-specific trends to the Clinical Billing Manager for process improvement.

8. Ensures authorizations are correctly linked to claims and reflect approved services.

9. Collaborates with the insurance verification and Medicaid eligibility team to confirm coverage, identify inactive pay sources, and secure necessary prior authorizations.

10. Communicates with Clinical Services Coordinates (CSC) and the Waiver Department as needed to confirm or resolve authorization issues. Recommends and submits write-offs for review and approval by the Clinical Billing Manager.

11. Identifies and reports accounts with atypical or questionable balances during monthly statement review.

12. Ensures billing practices comply with Medicaid, Medicare, and commercial insurance requirements.

13. Files and maintains Explanation of Benefits (EOBs), Remittance Advices (RAs), and related correspondence in an organized and secure manner.

14. Assists with insurance verification for new admissions to ensure accurate payment estimates prior to scheduling.

15. Supports ongoing departmental improvement efforts through open communication, documentation accuracy, and adherence to ACCESS billing procedures.

16. Completes approved in-service and professional development trainings as assigned.

17. Stays informed about updates to payer regulations, billing procedures, and internal processes.

18. Performs other related or assigned duties as needed to support departmental and organizational goals.

COMPETENCIES

Ethics and Integrity :

• Demonstrates honesty, professionalism, and adherence to confidentiality.
• Upholds ACCESS mission, values, and standards.

Dependability and Accountability :

Communication and Interpersonal Skills :

Problem Solving and Initiative :

Organization and Planning :

Teamwork and Collaboration :

PHYSICAL DEMANDS

Requirements

QUALIFICATIONS

Education / Certification :

Experience / Knowledge required :

Skills / Abilities :

Ability to problem-solve and work independently while maintaining team

TRAVEL REQUIREMENTS