Billing Specialist

As a Partner in Wellbeing, the Billing Specialist comprehensively supports Alluma’s behavioral health revenue cycle operations. In this position, you will be accountable for various responsibilities requiring data analysis, in-depth evaluation, and sound judgement. The daily duties include claim processing, denial management, cash application, and assistance with eligibility verification. Other responsibilities may include obtaining and verifying authorizations, investigating, and appealing denied claims and working on special projects.

Essential Responsibilities

Claim Processing

• Prepare, review, and submit claims to various payers.
• Identify and bill secondary or tertiary insurances.
• Works in conjunction with the access team to ensure clean billing.
• Balances daily batches and reports.
• Resubmits claims to insurance companies as necessary.
• Review insurance payment for accuracy and compliance with contract discount.
• Review electronic explanation of benefits from the insurance company, post the contractual obligation, the client liability and payment received to the client’s account.
• Post insurance payment within the Electronic Health Record (EHR) accurately and timely.
• Contact insurance companies regarding payment discrepancies on moderately complex payment variances.
• Assure claim timely filing deadlines achieved.

Denials

• Investigate, resolve, and respond to behavioral health insurance claim denials which involves research, analysis and problem solving.
• Research and appeal denied claims.
• Generate retractions or voids upon resolution of denied claims.

Client Invoicing

• Generate reports and review to ensure accuracy of client statements.
• Review client bills for accuracy and completeness.
• Obtain missing client information and update client records.
• Identify resolve client billing complaints.
• Answer client and/or insurance inquiries.

Support the Billing Coordinator in resolving complex or escalated issues by researching information and proposing and/or developing effective solutions.

Work on special projects that increase efficiencies, improve workflows, and resolve issues which deliver positive financial impact.

Coordinate cross-functionally to aid with coding and credentialing questions.

Administer routine maintenance and standard EHR functions.