Medical Biller

Key Responsibilities 

• Submit ABA authorization requests and extension requests to insurance companies.
• Follow up with insurance case coordinators, including BCBS Illinois and other payors, regarding pending authorization requests.
• Audit clinical packets, supporting documentation, and assessments required for authorization approvals.
• Track authorization due dates and renewal timelines using Monday.com and other tracking systems.
• Support the development and submission of authorization appeals when services are denied or reduced.
• Review, scrub, and submit electronic and paper claims for ABA and therapy services.
• Research and resolve claim rejections, denials, and payment delays.
• Investigate payer-specific billing issues and implement corrective actions.
• Manage claim aging reports and follow up on outstanding accounts receivable balances for all disciplines.
• Write and submit claims appealing to recover denied reimbursement.
• Verify insurance eligibility, benefits, authorizations, and coverage requirements, primarily for ABA services.
• Document benefit information, authorization requirements, and payer communications in Central Reach.
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
• Post payments accurately and reconcile insurance payments.
• Identify denial trends and develop action plans for resolution.
• Complete Work-In-Progress (WIP) documentation by recording ERA dates, payment amounts, adjustments, and write-offs.
• Process and monitor secondary insurance billing for all disciplines.
• Track recoupments and overpayment requests received by mail and electronically, ensuring validity before repayment.
• Maintain detailed documentation of insurance calls, payer correspondence, and critical communications within Central Reach.
• Respond promptly to Teams messages, emails, and internal requests.
• Open and review insurance correspondence, identifying denials, requests for records, and reimbursement issues.
• Collaborate with clinical, scheduling, and leadership teams to resolve billing and authorization concerns.
• Monitor clean claim ratios and claim generation accuracy.
• Recommend process improvements to enhance reimbursement rates and operational efficiency.

Education

• Associate's or bachelor’s degree in healthcare administration, Business, Accounting, or related field is required.

Experience

• Minimum 3 to 5 years of medical billing, insurance authorization, or revenue cycle experience.
• Prior experience with ABA billing and pediatric therapy services in behavioral health strongly preferred.
• Proven experience managing insurance denials, appeals, and authorizations.
• Proficiency with Central Reach or similar practice management systems.
• Experience with insurance clearinghouses and claims management platforms.
• Strong Microsoft 365 skills, including Excel, Outlook, Teams, and Word.
• Knowledge of Medicaid, Medicare, BCBS, and commercial insurance plans.
• Experience preparing authorization and claims appeals.
• Ability to communicate effectively via phone, email, and virtual platforms.
• Ability to manage detailed administrative work with a high level of accuracy.

Knowledge & Competencies

• Strong understanding of insurance billing processes, EOB interpretation, and revenue cycle management.
• Familiarity with payer requirements, authorization procedures, and pediatric therapy reimbursement guidelines.
• Excellent written and verbal communication skills.
• Strong organizational and time management abilities.
• Ability to manage multiple priorities while maintaining accuracy and compliance.
• Demonstrated problem-solving and analytical skills.