Job Description

Required Experience & Essential Skills

1-3 years of experience in healthcare billing/collections, health insurance interactions, or patient financial services
Experience with insurance verification, claims processing, and accounts receivable
Knowledge of healthcare billing regulations and HIPAA compliance requirements
Strong customer service background with experience in sensitive financial conversations
Excellent communication skills, both written and verbal
Ability to resolve complex roadblocks independently and maintain diligent follow-up processes
Willingness to go above and beyond to connect families with resources and help them navigate payment for services
Familiarity with ABA Services preferred (CPT Codes 97151-97158) and Medicaid eligibility
Familiarity with EHR systems (CentralReach preferred), and Microsoft Office Suite (Excel, Word, Outlook)
Detail-oriented with strong organizational and time management skills
Ability to work independently and manage multiple priorities in a fast-paced environment
Familiarity working with both commercial insurance and government-funded (i.e., Medicaid and TRICARE) healthcare payors
Demonstrated experience driving payor accountability – comfortable pushing on payors and advocating for insurance coverage and timely claims payment on behalf of clients
Experience working with families or in pediatric, third-party reimbursed healthcare settings preferred

Patient Responsibility Collections
Manage patient responsibility accounts with kindness and professionalism
Develop and maintain flexible payment plans tailored to each family's unique financial circumstances, while ensuring ongoing adherence to agreed upon plans
Maintain detailed records of all collection activities, payment arrangements, and family communications
Monitor A/R aging reports to prioritize collection efforts
Process patient payments and apply them accurately to appropriate accounts and services
Family Resources & Support
Research and identify financial assistance programs, grants, and community resources offering financial support for families receiving autism services
Proactively connect families with autism-specific funding organizations and state assistance programs, and nonprofit resources
Maintain a comprehensive database of local and national resources for easy family referrals
Create educational tools and step-by-step guides for families to independently and easily access available financial assistance programs
Advocate for families during financial hardship by exploring all available support options
Benefits & Eligibility Checks
Primary point of contact, managing relationship with third-party automated insurance verification partner.
Manage our automated insurance verification process using our third-party benefits verification platform for all new intake clients and ongoing verification for existing clients
Review monthly eligibility checks to ensure continuous coverage and proactively identify policy changes
Determine and communicate to families applicable ABA coverage limits and exclusions, deductibles, copayments, and authorization requirements
Provide clear, understandable explanations to families about their insurance benefits, coverage details, and anticipated out-of-pocket costs based on verification results
Maintain accurate and up-to-date insurance information in patient records and promptly update any changes identified
When insurance changes occur, coordinate seamlessly across authorizations, scheduling, credentialing, and billing teams to ensure uninterrupted continuation of care
Identify potential coverage gaps through platform reporting and work with families to secure alternative funding sources before service interruption
Troubleshoot any platform issues and escalate complex verification cases to vendor support when needed
Claims Reprocessing & Appeals
Reprocess insurance claims when patient financial obligations have been incorrectly calculated or applied by insurance carriers
Prepare and file formal appeals for incorrectly denied claims, including compilation and submission of supporting clinical documentation
Track appeal outcomes and follow up on pending decisions within established timeframes
Maintain detailed logs of all reprocessing activities and communicate outcomes to relevant stakeholders
Payor Claims Enrollment (EFT & ERA enrollments)
Complete Electronic Funds Transfer (EFT) enrollment applications for new insurance payors
Set up Electronic Remittance Advice (ERA) enrollments to streamline payment processing and reconciliation
Maintain current enrollment status for all active insurance contracts and renew as needed
Proactively troubleshoot EFT and ERA processing issues and coordinate resolution with payor representatives
Update banking and contact information for electronic payment systems as organizational changes occur