Overview
A healthcare organization specializing in Applied Behavior Analysis (ABA) services for children with autism spectrum disorder (ASD) is seeking a compassionate and detail-oriented Billing Specialist. This role focuses on patient responsibility collections while supporting families throughout their ABA treatment journey. The Billing Specialist will combine expertise in insurance patient responsibility collections with strong family advocacy, helping families access resources to cover treatment costs and ensuring effective billing processes.
Responsibilities
Patient Responsibility Collections
- Manage patient responsibility accounts with professionalism and empathy
- Develop and maintain flexible payment plans tailored to each family's financial situation
- Maintain detailed records of collection activities, payment arrangements, and family communications
- Monitor accounts receivable aging reports to prioritize collection efforts
- Process patient payments accurately and apply them to appropriate accounts and services
Family Resources & Support
- Research and identify financial assistance programs, grants, and community resources for families receiving autism services
- Connect families proactively with autism-specific funding organizations, state assistance programs, and nonprofit resources
- Maintain a comprehensive database of local and national resources for family referrals
- Create educational tools and guides to help families access financial assistance programs independently
- Advocate for families experiencing financial hardship by exploring all available support options
Benefits & Eligibility Checks
- Serve as the primary contact managing relationships with third-party automated insurance verification partners
- Manage automated insurance verification for new and existing clients using third-party benefits verification platforms
- Review monthly eligibility checks to ensure continuous coverage and identify policy changes
- Communicate ABA coverage limits, exclusions, deductibles, copayments, and authorization requirements clearly to families
- Maintain accurate and up-to-date insurance information in patient records
- Coordinate across authorizations, scheduling, credentialing, and billing teams to ensure uninterrupted care when insurance changes occur
- Identify potential coverage gaps and work with families to secure alternative funding before service interruptions
- Troubleshoot platform issues and escalate complex cases to vendor support as needed
Claims Reprocessing & Appeals
- Reprocess insurance claims when patient financial obligations are incorrectly calculated or applied
- Prepare and file formal appeals for denied claims, including compiling and submitting supporting clinical documentation
- Track appeal outcomes and follow up on pending decisions within established timeframes
- Maintain detailed logs of reprocessing activities and communicate outcomes to relevant stakeholders
Payor Claims Enrollment (EFT & ERA Enrollments)
- Complete Electronic Funds Transfer (EFT) enrollment applications for new insurance payors
- Set up Electronic Remittance Advice (ERA) enrollments to streamline payment processing and reconciliation
- Maintain current enrollment status for all active insurance contracts and renew as needed
- Troubleshoot EFT and ERA processing issues and coordinate resolution with payor representatives
- Update banking and contact information for electronic payment systems as organizational changes occur
Requirements
- 1-3 years of experience in healthcare billing/collections, health insurance interactions, or patient financial services
- Experience with insurance verification, claims processing, and accounts receivable
- Knowledge of healthcare billing regulations and HIPAA compliance
- Strong customer service skills with experience handling sensitive financial conversations
- Excellent written and verbal communication skills
- Ability to resolve complex issues independently and maintain diligent follow-up
- Willingness to assist families in navigating payment for services and connecting them with resources
- Familiarity with ABA services (CPT Codes 97151-97158) and Medicaid eligibility preferred
- Experience with EHR systems (CentralReach preferred) and Microsoft Office Suite (Excel, Word, Outlook)
- Detail-oriented with strong organizational and time management skills
- Ability to work independently and manage multiple priorities in a fast-paced environment
- Experience working with commercial insurance and government-funded payors (Medicaid, TRICARE)
- Demonstrated ability to advocate for insurance coverage and timely claims payment
- Experience working with families or in pediatric, third-party reimbursed healthcare settings preferred
Compensation & Benefits
Details regarding compensation and benefits will be provided during the hiring process.
Location
This position is based in North Carolina or Georgia, supporting ABA services within these regions.
The organization is an equal opportunity employer committed to diversity and inclusion. All qualified applicants will receive consideration without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Artificial intelligence tools may be used to assist in parts of the hiring process, but final hiring decisions are made by human recruiters.