Billing and Claims Specialist

Job Overview:
EPC Billing is seeking a proactive and experienced Billing and Claims Specialist to lead our billing operations. As the Billing and Claims Specialist, you will be responsible for overseeing the entire billing process, ensuring accurate and timely submission of claims, managing insurance verifications, repricing, and leading the resolution of claims. This role is crucial for ensuring a smooth revenue cycle for our Substance Abuse and Mental Health programs, including outpatient and detox services.

Key Responsibilities:

• Manage and oversee the entire billing process, including claim submission, follow-up, and payment posting for Substance Abuse and Mental Health programs.
• Verify patient insurance coverage and eligibility, ensuring accurate claims are submitted to payers.
• Lead the resolution of denied or rejected claims, including claim corrections and resubmissions to secure timely and accurate payments.
• Handle the claims appeal process, working closely with payers to resolve disputes and ensure full reimbursement.
• Negotiate reimbursement rates with insurance companies, ensuring adherence to contract terms and maximizing revenue.
• Monitor and analyze claim data, identify trends, and implement corrective actions to address underpayments or billing inefficiencies.
• Stay up to date with payer requirements, billing codes (CPT, ICD-10), and best practices for Substance Abuse and Mental Health billing.
• Ensure compliance with all regulatory requirements, including HIPAA, and handle patient information securely and confidentially.
• Collaborate with other departments, including the Authorization and Compliance Specialist, to optimize billing and ensure smooth operations.
• Provide regular reporting on billing and claims performance to senior management.

Qualifications:

• Minimum of 2 years of experience in medical billing, with a strong focus on Substance Abuse and Mental Health programs.
• Proven leadership experience in managing a billing team or overseeing complex billing processes.
• In-depth knowledge of medical billing procedures, insurance processes, and claims management.
• Experience with medical billing software, such as Collaborative MD, KIPU or Kareo, is highly desirable.
• Proficient in medical coding (CPT, ICD-10, HCPCS) and claims resolution processes.
• Strong analytical and negotiation skills, with experience resolving claim disputes and managing repricing.
• Excellent communication and interpersonal skills for working with insurance payers and internal teams.
• Familiarity with HIPAA regulations and healthcare compliance standards.

Education:

• High School Diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration, finance, or related field preferred.
• Certification in Medical Billing or Coding is a plus (e.g., CPC, CPB).

Job Type: Full-time

Pay: $62,340.00 - $65,474.00 per year

Benefits:

• Paid time off

Schedule:

• Monday to Friday

Ability to Relocate:

• Braintree, MA 02184: Relocate before starting work (Required)

Work Location: In person

Salary : $62,340 - $65,474