DUTIES AND RESPONSIBILITIES

Identifies, researches, and resolves billing issues, claim rejections, denials, and payment discrepancies for ABA, Speech Therapy, and Occupational Therapy services. Reviews claims for accuracy and completeness prior to submission, including patient information, insurance coverage, authorization requirements, CPT codes, ICD-10 diagnosis codes, modifiers, units, dates of service, and provider information. Audits patient accounts and insurance payments to identify underpayments, overpayments, duplicate payments, incorrect adjustments, missing charges, and outstanding balances. Reviews billing records for compliance with payer requirements, company policies, contractual agreements, and applicable billing guidelines. Prepares and submits appeals for denied or underpaid claims, including supporting documentation, medical records, authorizations, and other information required by insurance payers. Corrects and resubmits rejected or denied claims and follows up with insurance companies until claims are appropriately resolved. Codes and reviews services using appropriate CPT, HCPCS, ICD-10, modifiers, and payer-specific billing requirements. Charging patient payments, credits, and other account transactions accurately within the billing system. Researches and processes patient and insurance refunds, credit balances, and overpayments. Performs accounts receivable follow-up and monitors aging reports to identify unpaid, delayed, or incorrectly processed claims. Prepares correspondence, collection notices, appeal letters, and other billing-related communications. Communicates with insurance companies, patients, providers, therapists, and internal departments to resolve billing and reimbursement issues. Enters charges and billing information from clinical documentation into the billing system and verifies accuracy before claim submission. Generates and submits electronic claims and patient statements according to established billing schedules. Tracks denial trends, payer issues, reimbursement discrepancies, and recurring billing errors and reports findings to management. Assists with identifying process improvements to strengthen billing accuracy, compliance, collections, and overall revenue-cycle performance. Maintains confidentiality of patient and financial information and follows HIPAA requirements and organizational policies. Answers billing-related phone calls and assists patients with account balances, insurance questions, statements, and payment concerns. Maintains organized and accurate billing records and supporting documentation for internal and external audits. Performs other related billing, auditing, accounts receivable, and revenue-cycle duties as assigned by management. Experience handling insurance company audits, including preparing and providing requested billing records, claims, authorizations, and supporting documentation during a payer audit.

Job Type:

Full-time Pay:

From $25.00 per hour Expected hours: 40.0 per week

Benefits:

Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person