Claims Resolution Specialist

Claims Resolution Specialist Behavioral Health Exact Billing Solutions (EBS), Lauderdale Lakes, FL
Pay Range

Base pay: $58,240.00/yr $64,480.00/yr (exact amount will be based on skill and experience).

About Exact Billing Solutions

Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in substance use disorder, mental health, and autism care. With proprietary billing processes, deep industry knowledge, and a reputation for innovation, EBS helps partner healthcare companies streamline operations and accelerate cash flow. Company values: integrity, dependability, and attention to detail.

Role Overview

As a Claims Resolution Specialist Behavioral Health, you will coordinate with insurance companies and clients to secure maximum benefits. The role supports multiple expanding clinic locations; timely collections are critical to our operations and directly impact client families and children.

Key Responsibilities

• Review and manage assigned accounts receivable inventory to ensure timely follow?up on outstanding claims.
• Investigate and resolve denials, rejections, and underpayments by working directly with payors and internal teams.
• Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.
• Document all collection activities clearly and accurately within our systems.
• Monitor payor trends and elevate recurring issues to leadership.
• Meet or exceed daily, weekly, and monthly productivity and quality standards.
• Support special projects and process improvement initiatives as assigned.
• Maintain effective communication with third?party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction.
• Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc.
• Enter status claims and add notes in the patient accounting system (CollaborateMD).
• Escalate any payor or client claim issues to department leadership.
• Establish/maintain effective communications with the leadership team to ensure compliance with third?party guidelines.
• Update patient demographics and insurance information as needed.
• Maintain productivity KPI metrics.
  

Requirements

• Review and manage assigned AR inventory to ensure timely follow?up on outstanding claims.
• Investigate and resolve denials, rejections, and underpayments by working directly with payors, and internal teams.
• Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.
• Document all collection activities clearly and accurately within our systems.
• Monitor payor trends and elevate recurring issues to leadership.
• Meet or exceed daily, weekly, and monthly productivity and quality standards.
• Support special projects and process improvement initiatives as assigned.
• Maintain effective communication with third?party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction.
• Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc.
• Enter status claims and add notes in the patient accounting system (CollaborateMD).
• Escalate any payor or client claim issues to department leadership.
• Establish/maintain effective communications with the leadership team to ensure compliance with third?party guidelines.
• Update patient demographics and insurance information as needed.
• Maintain KPI metrics for productivity.
  

Qualifications

• Associates degree (preferred).
• At least 3 years of behavioral health out?of?network billing experience.
• Experience with CollaborateMD EMR and billing software.
• Experience with ABA therapy (preferred).
• Knowledge of CPT and ICD?10 codes (preferred).
• Claims denial experience with follow?up from payers including appeals.
  

Benefits

• 21 paid days off (15 days PTO, increasing with tenure, plus 6 holidays).
• Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
• Medical, dental, vision, long?term disability, and life insurance.
• Generous 401(k) with up to 6% employer match.
  

Culture & Compliance

Integrity, dependability, and attention to detail are the cornerstones of our team. We are a fast?paced, growing company dedicated to enabling clients to spend more time helping people. Exact Billing Solutions participates in the U.S. Department of Homeland Security E?Verify program.

Additional Information

• Seniority Level: Associate
• Employment Type: Full?time
• Job Function: Other
• Industries: IT Services and IT Consulting
  

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