Billing Specialist

The Billing Specialist supports the revenue cycle for behavioral health claims across multiple Pennsylvania insurance payers. The role focuses on submitting clean claims, working outstanding balances, resolving denials and rejections, and ensuring no revenue is lost to timely filing.
In addition to core billing responsibilities, the specialist will be trained on the full Accounts Receivable cycle including pre-billing review, cash posting, and aging follow-up.
Duties and responsibilities:Pre-Billing Review: Run required reports before each billing cycle to identify incomplete notes, missing authorizations, and billing setup issues. Document findings and flag all blockers before any batch is released.Claim Submission: Prepare and submit clean, accurate claims to insurance payers through Inovalon. Verify CPT codes, place of service, rendering provider NPIs, and authorization numbers before submission.Rejection Follow-Up: Review all claim statuses the day after billing. Identify rejections and transmission errors, correct and resubmit same day, and document all activity in the shared tracking log.Denial Management: Work the denial queue daily. Identify root causes, escalate all denials to the Director of Billing the same day, and prepare appeals with supporting documentation where applicable.Insurance Communication: Follow up with insurance companies via portal and phone on unpaid or denied claims, clarify statuses, and escalate unresolved issues proactively.Documentation and Reporting: Maintain accurate, detailed logs of claim actions, follow-up activity, and outcomes. Every claim must have a documented next step at all timesPrior medical billing or healthcare AR experience is preferred; behavioral health billing is a plus.
Qualifications:Preferably have basic Excel knowledgeBe able to prioritize and meet deadlinesBe able to work independently and proactivelyBe attentive to details and accurate in documentationBe patient yet assertive when dealing with insurance representativesBe able to rapidly learn new systems, payer rules, and billing workflowsHave excellent organizational skillsHave strong verbal and written communication skillsPossess basic computer skills, including Microsoft Office Suite