Medical Billing Specialist

Medical Billing Specialist

Reports to: Director of Innovation & Strategy

Department: Billing & Revenue Cycle Management

Employment Type: Part-Time 20 hours for the first 3-4 months, then move to full-time 40 hours

Position Overview:

The Medical Billing Specialist (MBS) is a vital member of our team, responsible for managing end-to-end revenue cycle functions including claims submissions, authorizations, insurance contracting, charge master maintenance, and appeals. This position ensures accuracy, timeliness, and compliance in all billing operations for our Intensive Outpatient Programs (IOP) and Partial Hospitalization Programs (PHP), serving both youth and adult behavioral health populations in Oregon. The MBS will perform eligibility/enrollment checks, create financial cost breakdowns for clients based on their benefits, and maintain positive insurance payer relations in authorizations, appeals, single case agreements, and claims. This role plays a critical role in supporting financial sustainability and client accessibility.

Key Responsibilities:

• Authorizations Management: Proactively obtain and manage authorizations for IOP/PHP services and maintain documentation to support billing.
• Insurance Contracting Support: Assist with insurance payer contracting processes, including renewals and contract compliance monitoring.
• Provider Credentialing/Recredentialing Management: Handle all necessary forms and documentation for provider credentialing with insurance payers, to include provider roster updates, facility demographic information changes, provider portal updates (Availity, OneHealthPort, etc.), and CAQH profiles .
• Charge Master Maintenance: Update and manage the charge master to ensure accurate service coding and pricing in alignment with negotiated contractual rates and applicable fee schedules/Relative Value Units (RVUs)
• Eligibility Checks & Enrollment: Conduct patient eligibility/enrollment verifications and communicate benefit coverage details to clients and internal teams.
• Financial Cost Breakdown: Provide cost estimates for clients, ensuring transparency in service pricing and payment responsibilities.
• SCA (Single Case Agreements) Handling: Negotiate and process SCAs for out-of-network clients, coordinating with clinical and administrative teams.
• Appeals & Denials Management: Handle the appeals process for denied authorizations and claims, coordinate appeal letters, compile clinical documentation, and maintain timely communication with insurance payers.
• Compliance & Regulations: Ensure compliance with HIPAA, CPT/ICD-10 coding standards, Oregon Administrative Rules (OAR), and payer-specific guidelines.
• Claims Submission & Payment Posting: Submit clean claims to insurance payers, ensuring compliance with payer guidelines, and post payments accurately.
• Account Reconciliation & Dispute Resolution: Regularly reconcile patient accounts, identify discrepancies, and manage insurance provider inquiries.
• Communication & Coordination: Collaborate with clinical, administrative, and client care coordination teams to ensure seamless financial operations.

Qualifications:

• High School Diploma or GED required; Associate's Degree in Medical Billing or related field preferred.
• Minimum 2 years experience working with credentialing, insurance contracting, authorization management, medical billing; behavioral health IOP/PHP billing experience preferred.
• Proficient with use of programs such as Excel/Google Sheets, medical billing software/clearinghouses, and electronic health records (EHR) systems.
• Solid understanding of CPT/HCPCS and ICD-10 coding.
• Experience with insurance verification, authorization workflows, payer contract management, rate setting using fee schedules, and credentialing.
• Strong analytical skills for account reconciliation and financial breakdowns.
• Excellent communication and problem-solving abilities.

Personal Attributes:

• Empathetic and customer-centric approach to maintaining relations with payors and handling financial discussions directly with clients.
• Detail-oriented with high standards for accuracy.
• Strong organizational skills and ability to manage multiple priorities.
• Committed to continuous learning and professional development.

Compensation & Benefits:

• Annual Salary Range: $68,000 - $75,000 (based on experience and qualifications)
• Work Environment: Fully Remote (Oregon-based applicants preferred)
• Health Insurance: Full coverage (Medical, Dental, Vision)
• Paid Time Off:
• 120 hours Vacation (15 days)
• 40 hours PTO (5 days)
• 64 hours Sick Leave (8 days)
• Major Holidays
• Company-provided Equipment: Laptop (Mac or PC)
• Other Benefits: Flexible scheduling, team collaboration, opportunities for professional growth.

Job Type: Full-time

Pay: $69, $74,500.00 per year

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Experience:

• Medical billing: 3 years (Required)
• managing insurance authorizations: 3 years (Preferred)
• insurance credentialing: 3 years (Required)

Shift availability:

• Day Shift (Required)

Work Location: Remote