EEOC Statement:

We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. 

Job Summary:

This position is responsible for ensuring claims are submitted in an accurate and timely matter; contacting clients for payment and setting up payment plans; review sliding fee applications, and initiate collections procedure if applicable. Posting manual payments into Carelogic in a timely and accurate manner. This position is also responsible for processing payments and adjustments; compiling and balancing bank deposits; and initiating payment refunds. The Lead Specialist is also responsible for researching appropriate reimbursement amounts and resolving payment variances.

Supervisory Responsibilities:

• No

Duties/Responsibilities:

• Submit and track insurance claims to ensure timely reimbursement

• Identify and resolve denied, rejected, or underpaid claims

• Conduct thorough follow-ups on outstanding insurance balances

• Process secondary and tertiary claims as needed

• Analyze and resolve claim denials through appropriate appeal processes

• Draft and submit effective appeal letters with supporting documentation

• Work with insurance representatives to clarify claim issues and payment discrepancies

• Monitor and follow up on patient balances to ensure prompt payment

• Communicate professionally with patients regarding outstanding balances, payment plans, and billing inquiries

• Generate and send patient statements

• Collaborate with front desk and scheduling teams to verify patient insurance eligibility and collect upfront payments when necessary

• Other duties as assigned.

Required Knowledge, Skills, and Abilities: 

• Working knowledge of medical billing and insurance companies.

• Strong organizational, critical thinking skills, and management skills.

• Strong analytical skills, attention to detail and accuracy.

• Ability to work independently and prioritize tasks.

• Excellent communication skills when dealing with patients, families, public, co-workers, and professional offices

• Knowledge of HIPAA privacy standards and PCI compliance regulations

• Proficient use of systems (computer, applications, phone systems)

• An effective collaborator who understands the importance of supporting the office, clients, and co-workers.

• Excellent written and verbal communication skills and phone etiquette skills.

• Must be able to read, write, and speak English fluently.

• Fluency in a second language is preferred but not required.

Education and Experience:

• 2 Year or Associates Degree in Health Management and/or Medical Billing or equivalent experience.

• Four or more years of administrative work experience

• Two years of customer service experience

• Experience in insurance claiming industry preferable

• Knowledge of/ and experience in mental health environment preferable

Physical Requirements: 

• Mainly sitting with limited bending and lifting possible.

Work Environment:

• Office

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.