Billing Specialist
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AI Summary
The Billing Specialist is responsible for managing the full revenue cycle, including insurance verification, claim submission, payment posting, and denial management. They must ensure compliance with Minnesota DHS regulations and maintain accurate documentation within the Procentive electronic health record system.
Abria Recovery is seeking a detail-oriented Billing Specialist to support the billing operations for our outpatient substance use disorder treatment program (245G). This hands-on position is responsible for insurance verification, claim submission, payment posting, denial follow-up, accounts receivable and client billing. The Billing Specialist will utilize the Procentive electronic health record while ensuring compliance with Minnesota DHS regulations, payer requirements, and organizational policies.
Essential Responsibilities:
- Verify insurance eligibility and benefits prior to the start of services.
- Submit electronic insurance claims and client invoices accurately and timely through Procentive.
- Audit claims prior to submission to ensure accurate coding, documentation, and payer requirements are met.
- Follow up on rejected, denied, and unpaid claims to secure timely reimbursement.
- Research claim denials, make corrections, and submit appeals or corrected claims as appropriate.
- Accurately post insurance payments, client payments, contractual adjustments, and payment corrections.
- Reconcile Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs).
- Monitor accounts receivable and follow up on outstanding insurance and client balances.
- Complete required DAANES data entry accurately and within required timeframes.
- Monitor payer updates and maintain current payer information within the billing system.
- Respond professionally to client and payer inquiries regarding billing, insurance coverage, invoices, and payment questions.
- Collaborate with admissions, clinical, and administrative staff to resolve billing and documentation issues.
- Conduct daily claim audits to ensure billing accuracy and compliance.
- Maintain compliance with HIPAA, Minnesota DHS regulations, and organizational policies.
- Identify opportunities to improve billing accuracy, reduce denials, and enhance billing workflows.
Qualifications
- High school diploma or equivalent required; Associate's degree in Healthcare Administration, Business, Accounting, or a related field preferred.
- Minimum of two years of medical billing experience, preferably in behavioral health or substance use disorder treatment.
- Experience with Procentive or similar electronic health record/billing systems preferred.
- Knowledge of Minnesota Medicaid (MHCP), commercial insurance billing, and DAANES reporting preferred.
- Strong attention to detail, organizational skills, and problem-solving abilities.
- Excellent communication and customer service skills.
- Ability to work independently while managing multiple priorities and deadlines.
Work Location
This is a fully remote position. Employees must maintain a reliable high-speed internet connection and a private, HIPAA-compliant workspace. Attendance at one mandatory Microsoft Teams meeting each month is required.
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