Insurance Verification and Billing Specialist

Job Summary

Responsible for managing the entire billing processes including submitting claims and following up on unpaid accounts while specializing in the intricacies of Behavioral Health billing requirements. This role requires a solid understanding of billing concepts, processes and procedures; does other related duties.

Essential Duties and Responsibilities

Note: The responsibilities outlined for this position are provided as examples and are intended to illustrate the scope of the role. These examples are not exhaustive and may vary based on the specific requirements of the position. Additional duties aligned with the role’s objectives may also be assigned.

i. Prepare and submit accurate billing data and medical claims for behavioral health services to insurance companies and government payers.

ii. Verify patient insurance coverage and eligibility, ensuring all required authorizations and documentation are in place.

iii. Monitor accounts for delinquent claims and establish payment arrangements with patients as necessary.

iv. Work claims and claim denials to ensure maximum reimbursement for services provided.

v. Handle rejected claims promptly, conducting thorough investigations to identify discrepancies and resubmitting claims as required.

vi. Maintain a comprehensive understanding of billing regulations and compliance requirements specific to Applied Behavior Analysis (ABA) and Division of Developmental Disabilities (DDD), ensuring adherence to legal and insurance
guidelines.

vii. Collaborate closely with healthcare providers to ensure accurate documentation is present for each claim submitted.

viii. Keep abreast of changes in billing codes, insurance policies, and compliance regulations so that all processes remain current and efficient.

ix. Maintain the highest standards of patient confidentiality as per Health Insurance Portability and Accountability Act (HIPAA) regulations.