Commercial Billing and Collections Specialist

4 weeks ago

Addison Texas, United States Behavioral Innovations Full time
Overview:
Fast Growing Healthcare Company seeking a Commercial Billing and Collections Specialist

 

Your Work and How You’ll Make a Difference:

 

The Commercial Collections Specialist ensures proper adjudication of all claims submitted to carriers while working within the deadlines and protocols of the assignments. This position will focus primarily on reviewing and assessing Commercial Carrier denials or returned claims. Must be able to communicate with all Commercial line of business (HMO, EPO and PPO, POS) from a resolution-based perspective. This communication should be focused on acquired knowledge, insurance carrier guidelines, company policies & procedures, research, and collection efforts.

 

Why choose Behavioral Innovations:

Daily Pay: Access your pay when you need it

Wellbeing Program: Equipping you with tools to achieve your wellness goals.

OVIA Health: A Women's Health App supporting you throughout the entire Parenthood Journey.

Employee Assistance Program (EAP): Comprehensive support for your mental, emotional, and physical health.

100% Tuition Reimbursement Program:We invest in your education for career advancement opportunities, including the path to becoming a BCBA.

Supportive Team Structure: Our clients and families are our top priority, and we foster a collaborative and expert team environment.

Additional Programs Offered at BI: ABA Intern, Referral Bonuses, Employee Recognition, Employee Perks.

Career Advancement Opportunities: Ongoing training & Professional development for all employees.

Insurance: Medical, Vision, Dental, and Supplemental Insurance Policies.

University Partnerships: Enjoy tuition rate discounts. 

Pet Insurance

 

Duties & Responsibilities

Analyze and evaluate Commercial claim payments using the company's systems and tools. Use payment documentation provided by payers to determine if the medical provider has been reimbursed in compliance with the applicable state fee schedule.

Conduct timely and thorough telephone follow-up with carrier to ensure claims with supporting documentation have been received and facilitate prompt reimbursement.

Assist in efficiently moving work through the department, working as part of a team. Identifying and investigating Medicaid claims issues to resolution/payment.

Identifies bad debt write-offs and A/R adjustments. Initiates write-offs and adjustments in accordance with policies and procedures.

File and handle confidential documentation and patient health information (PHI); adhere and follow all HIPAA mandated guidelines.

Follows up on claims submitted to ensure prompt and timely payment and escalates issues, as necessary.

Identifies any overpayments and/or duplicate payments and investigates and resolves accordingly.

Initiating claim adjustments and resubmission of claims to the Commercial carrier and or affiliate.

Evaluates payments/denials received for correctness and ensures they are applied accordingly.

 

What we are looking for

3-5 years of knowledge in a behavioral health or medical clinic setting preferred, but not necessary.

Associates degree preferred, will take five years’ experience in lieu of degree.

Exhibit high quality work and willing to learn and take on new tasks

Communicate clearly and initiative to identify and resolve issues

3-5 years of medical billing and collections experience required.

3-5 years of healthcare industry experience required.

Demonstrate resourcefulness and cooperation

Exhibit BI’s core values in all interactions

Upholding Integrity, Excellence, and the Heart of ABA: 

 

For over 22 years, Behavioral Innovations has been providing center-based, evidence-based ABA Therapy across Texas, Oklahoma, and Colorado. Our Culture of excellence, teamwork, and care is guided by our core values and mission. Join us in making a positive impact on the lives of children diagnosed with autism and other developmental disorders. At Behavioral Innovations (BI), our values drive us every day. Recognized with the Clinical Excellence Award in 2021, crowned Company of the Year in 2022, and listed on the prestigious Inc. 5000, we are proud to be one of America's Fastest Growing Private Companies. 

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