Job Description

• Follow up on outstanding insurance and patient balances to secure timely payment  
• Investigate and resolve denied, rejected, or underpaid claims with Medicaid, managed care organizations (MCOs), and commercial insurance payers  
• Review remittance advice (RA/EOB) and identify payment discrepancies or trends  
• Submit claim corrections, reconsiderations, appeals, and supporting documentation as needed  
• Maintain accurate documentation of account activity within billing systems  
• Work aging reports and prioritize accounts based on timely filing limits and reimbursement impact  
• Communicate with insurance representatives regarding claim status, authorization issues, and payment resolution  
• Collaborate with admissions, utilization review, credentialing, and billing teams to resolve claims issues  
• Identify recurring billing or authorization issues and escalate trends to leadership  
• Ensure compliance with payer guidelines, company policies, HIPAA, and confidentiality standards  
• Assist with patient account inquiries and payment arrangements as needed  
• Maintain productivity and collection goals established by the organization
   

• High school diploma or equivalent required; associate’s degree preferred  
• Minimum of 2 years of healthcare collections or medical billing experience preferred  
• Behavioral health, residential treatment, or Medicaid collections experience strongly preferred  
• Knowledge of insurance claims processing, denials management, and appeals  
• Familiarity with Medicaid and managed care payer guidelines  
• Strong analytical, organizational, and problem-solving skills  
• Excellent communication and customer service abilities  
• Ability to manage multiple accounts and deadlines effectively  
• Proficiency in Microsoft Office Suite and healthcare billing systems  
• Ability to pass a criminal background clearance check, drug screen, physical and TB test.  
   

• Experience with behavioral health, PRTF, or residential treatment billing  
• Understanding of authorizations, eligibility verification, and coordination of benefits  
• Knowledge of multi-state Medicaid billing processes