Billing Specialist

Overview

An innovative healthcare provider specializing in autism care is seeking a Billing Specialist to join their Revenue Cycle Management (RCM) team. The organization operates a network of clinics providing integrated and comprehensive services to children aged 6 and under with autism, focusing on the Early Start Denver Model (ESDM) therapy. The role supports the growth of the platform across multiple states.

Responsibilities

• Generate primary and secondary insurance claims, including auditing billing entries for accuracy in coding, diagnosis, authorization, provider, and location
• Identify and flag pre-claim Medical Unlikely Edits (MUEs)
• Submit claims through the clearinghouse and audit for rejections, correcting and resubmitting as needed
• Post payments accurately in the practice management software, reconcile electronic payments, and retrieve Explanation of Benefits (EOBs)/Electronic Remittance Advices (ERAs) from payor portals
• Evaluate and troubleshoot denied claims, communicate with payors, and review payor contracts to ensure accurate coding
• Collaborate cross-functionally to resolve discrepancies related to appointments, insurance, and authorizations
• Stay current on payor billing rule changes and update internal resources
• Manage patient invoicing, ensuring timely and accurate creation and communication of invoices
• Manage accounts receivable backlog by fixing and resubmitting denied claims, conducting root cause analysis on denials, and suggesting improvements to increase clean claim rates
• Maintain strict HIPAA compliance and foster a positive team environment

Requirements

Education

• Bachelor’s degree or equivalent work experience

Experience

• Minimum 1+ years of experience providing therapy or working in operations within an integrated autism care setting
• Proven track record as a top performer in current and previous roles
• Experience with analytical tools such as Excel or Google Sheets for data modeling and analysis
• Experience managing complex processes involving multiple stakeholders

Skills

• Proficiency in Excel or Google Sheets
• Strong interpersonal skills for effective collaboration with cross-functional teams and external payors
• Exceptional attention to detail, critical thinking, and excellent communication skills with clients and insurance companies

Compensation and Benefits

• Total annual compensation range: $61,000 - $66,000
• Base salary: $55,000 - $60,000 per year
• Bonus: Up to $6,000 annually (paid monthly in increments up to $500) based on RCM team performance against monthly metrics
• Benefits package includes medical, dental, vision, 401(k) with match after one year of service, 10 days PTO, and professional development opportunities
• 100% remote-based role with opportunities to travel to clinics or team meetings as needed

Location

Remote-based with potential travel to clinic locations

Interview Process

• Resume review
• Offline Google Sheets-based exercise
• Behavioral interview
• Offline case study
• Case study presentation

Candidates may progress through each step based on performance and hiring manager discretion.

Equal Opportunity Statement

The organization is committed to diversity and inclusion and is an equal opportunity employer. Discrimination or harassment based on race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability, or other protected characteristics is strictly prohibited.