Billing A/R Specialist

Summary:  

The Financial Counselor and A/R Specialist plays a critical role in the end-to-end management of claims related to denials and accounts receivable. This position collaborates with the Billing Liaison, Credentialing Department, and management to resolve claim denials, support appeals, and streamline front-end processes. The specialist will also ensure compliance, quality assurance, and continuous improvement across denial management workflows. This role requires excellent communication skills and the ability to interact with patients, staff, third-party payers, and vendors in a fast-paced behavioral health setting. 

Duties and Responsibilities: 

• Demonstrates understanding of the agency’s mission, core values, and vision in behaviors and decisions 

• Provides professional, responsive, and compassionate support to patients and families and de-escalates distressed patients to ensure a positive service experience 

• Answer all incoming calls in an efficient, pleasant, and professional manner and answer inquiries related to billing or insurance-related inquiries 

• Identifies and obtains necessary authorizations, pre-certifications, and referrals 

• Verifies insurance eligibility using EDI transactions, payer portals, and phone calls 

• Secures and scans required documents into the EHR system 

• Updates coordination of benefits (COB) and resubmits claims as needed 

• Review, follow up, and resolve insurance denials and underpaid claims by coordinating with the billing team (or other parties) to have resolution 

• Assist and educate staff on complex denial trends and appeal processes 

• Collaborate with management to improve denial tracking and QA processes 

• Submit corrected claims and appeal requests to insurance payers 

• Prepare and maintain Daily Claim Submission Logs ensuring timely submission 

• Review clearinghouse and payer reports for errors, and ensure re-queuing of claims 

• Ensure EDI/ERA enrollment processes are initiated and tracked for all clients 

• Complete and participate in month-end close activities, allocating appropriate time and resources to meet deadlines. 

• Report credentialing or file maintenance issues impacting claim submissions 

• Monitor claim life cycle, from creation to payer adjudication, ensuring compliance with federal/state billing regulations 

• Analyze and troubleshoot HIPAA X12 transactions (837, 835, 270/271, 276/277, 278) 

• Work with payers to optimize electronic claim and remittance processes 

• Submit supporting documents (e.g., medical records) via portals or fax as required 

• Maintain up-to-date client contact and insurance details in the system 

• Maintain appointment, correspondence, and records logs 

• Participate in ongoing training, seminars, and team meetings 

• Representing Anew Behavioral Health in a professional manner to clients and vendors 

• Perform other administrative or billing-related duties as assigned 

Supervision Given:  

This position does not supervise any staff. 

Supervision Received:  

The Billing Financial Counselor A/R Specialist reports to the Billing Director. 

Qualifications: 

• 2–3+ years in medical billing or A/R, with emphasis in behavioral/mental health preferred 

• Solid knowledge of the claims life cycle and common denial reasons 

• Proficient with CPT codes (psychiatric), ICD-10, HIPAA standards, and insurance reimbursement processes 

• Experience with EHRs and billing software  

• Proficiency in Microsoft Office Suite (Excel, Word, Outlook) 

• Strong attention to detail, organizational skills, and problem-solving abilities 

• Excellent written and verbal communication skills 

• Ability to manage multiple priorities in a deadline-driven environment 

• Maintains patient confidentiality in compliance with HIPAA regulations 

Education: 

High School Diploma or GED required. 

Certification: 

CPR certification is preferred. 

NPI number/Ohio Medicaid ID is required (instructions on how to apply will be provided). 

Experience: 

Minimum of 3 years in behavioral health or a related field is preferred, but not mandatory. 

Physical Effort: 

Requires sitting for extended periods and occasional lifting of up to 20 pounds. 

Background: 

Must pass all Federal and State background checks according to company policy. 

Schedule: 

Flexible scheduling options allow for accommodating personal availability, enabling as little or as much work as desired 

Benefits: 

There are no benefits with this position.