Medical Billing Specialist

Medical Billing Specialist

Overview

We are seeking a skilled and motivated Medical Billing Specialist to join our psychiatric private practice and substance use disorder treatment center. In this essential role, you will focus on managing insurance accounts receivable, ensuring timely and accurate billing processes. Your expertise will be vital in verifying insurance coverage, submitting claims, following up on denials, and optimizing reimbursements. You will play a crucial role in streamlining our financial operations, enhancing cash flow, and improving the overall patient experience. This position is primarily in-office, with the flexibility of occasional remote workdays.

Core Responsibilities

• Process and submit insurance claims for mental health and substance use disorder services, ensuring accurate coding and documentation.
• Verify patient insurance benefits and eligibility prior to service delivery.
• Review claims for accuracy, ensuring all required documentation is included and compliant with payer requirements.
• Follow up on unpaid or denied claims, conducting thorough research to resolve issues and refile claims as necessary.
• Maintain accurate records of claims submissions, payments, and denials in the billing system.
• Communicate effectively with insurance companies to obtain authorizations and resolve billing inquiries.
• Educate patients about their financial responsibilities and insurance coverage, providing support for payment plans when necessary.
• Monitor and report on billing metrics, identifying trends in denials and areas for process improvement.
• Collaborate with clinical staff to ensure proper documentation of services for billing purposes.
• Assist in audits and compliance reviews to ensure adherence to all regulatory and payer guidelines.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, or related field or equivalent job experience.
• Intermediate knowledge of EMR systems, preferably AdvancedMD.
• Compliance with HIPAA, state regulations, and payer guidelines.
• Understanding of the revenue cycle management process in a medical practice.
• 1-2 years of experience working in Microsoft Office Suite (with an emphasis on Excel).

Preferred Skills

• 1-3 years of experience with denied claims and the refiling process for insurance carriers.
• Experience billing ICD-10, CPT, and HCPCS coding systems.
• 1-2 years of customer service experience.

Soft Skills/Behavioral Competencies

• Patient-Centered Focus: Demonstrates a commitment to ensuring patients understand their financial responsibilities and advocating for their best interests throughout the billing process.
• Attention to Detail: Maintains high accuracy in reviewing patient charts, coding, and claims to prevent costly errors and ensure compliance.
• Self-Starter: Highly organized and self-motivated, able to prioritize tasks effectively while managing high volumes of billing activities and tight deadlines.
• Adaptability: Proficient in troubleshooting billing issues, analyzing denial patterns, and adjusting to changes in payer policies and operational needs.
• Conflict Resolution: Skilled in addressing and resolving insurance-related issues, claims disputes, and coverage questions with professionalism and empathy.
• Collaborative Team Player: Strong interpersonal skills that facilitate effective communication and cooperation with clinical staff, admissions personnel, and financial teams.

Benefits

• Benefits: Comprehensive healthcare package (medical, dental, vision) and 401k administration.
• Work Environment: In-office position located in Raleigh, NC with occasional work-from-home flexibility.

Opportunities for Growth

At The Advaita Collective, we believe in fostering professional development and offering clear pathways for career advancement. As a Medical Billing Specialist, you will have the following opportunities:

• Hands-On Training: Train directly under experienced billing and clinical professionals, gaining valuable insights into the intricacies of facility billing, insurance verification, and clinical documentation.
• Direct Oversight and Mentorship: Report directly to our Revenue Cycle Manager, who will provide you with ongoing mentorship and guidance to develop your skills in revenue cycle management.
• Career Advancement: Successful candidates will have the opportunity to advance into a Revenue Cycle Associate role. This position involves broader responsibility for managing Accounts Receivable (A/R) and handling denials across our diverse practices, offering a chance to expand your expertise and take on a larger leadership role within the organization.

About Us

At The Advaita Collective, we offer a comprehensive range of behavioral healthcare services, including therapy, medication management, and substance use disorder treatment. Our mission is to expand access to high-quality, affordable healthcare and foster long-term wellness through a whole-person approach. From day one of each patient’s wellness journey, our dedicated team of physicians, therapists, and coaches collaborates to personalize and enhance their experience at our practice. By prioritizing holistic health over symptom-focused care, we empower our patients to build meaningful, fulfilling lives.