Exact Billing Solutions
Claims Resolution Specialist
Exact Billing Solutions, Deerfield Beach, Florida, United States, 33441
Claims Resolution Specialist – Behavioral Health – Exact Billing Solutions (EBS), Lauderdale Lakes, FL
Pay Range
Base pay: $58,240.00/yr – $64,480.00/yr (exact amount will be based on skill and experience).
About Exact Billing Solutions Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in substance use disorder, mental health, and autism care. With proprietary billing processes, deep industry knowledge, and a reputation for innovation, EBS helps partner healthcare companies streamline operations and accelerate cash flow. Company values: integrity, dependability, and attention to detail.
Role Overview As a Claims Resolution Specialist – Behavioral Health, you will coordinate with insurance companies and clients to secure maximum benefits. The role supports multiple expanding clinic locations; timely collections are critical to our operations and directly impact client families and children.
Key Responsibilities
Review and manage assigned accounts receivable inventory to ensure timely follow‑up on outstanding claims.
Investigate and resolve denials, rejections, and underpayments by working directly with payors and internal teams.
Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.
Document all collection activities clearly and accurately within our systems.
Monitor payor trends and elevate recurring issues to leadership.
Meet or exceed daily, weekly, and monthly productivity and quality standards.
Support special projects and process improvement initiatives as assigned.
Maintain effective communication with third‑party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction.
Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc.
Enter status claims and add notes in the patient accounting system (CollaborateMD).
Escalate any payor or client claim issues to department leadership.
Establish/maintain effective communications with the leadership team to ensure compliance with third‑party guidelines.
Update patient demographics and insurance information as needed.
Maintain productivity KPI metrics.
Requirements
Review and manage assigned AR inventory to ensure timely follow‑up on outstanding claims.
Investigate and resolve denials, rejections, and underpayments by working directly with payors, and internal teams.
Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.
Document all collection activities clearly and accurately within our systems.
Monitor payor trends and elevate recurring issues to leadership.
Meet or exceed daily, weekly, and monthly productivity and quality standards.
Support special projects and process improvement initiatives as assigned.
Maintain effective communication with third‑party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction.
Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc.
Enter status claims and add notes in the patient accounting system (CollaborateMD).
Escalate any payor or client claim issues to department leadership.
Establish/maintain effective communications with the leadership team to ensure compliance with third‑party guidelines.
Update patient demographics and insurance information as needed.
Maintain KPI metrics for productivity.
Qualifications
Associate’s degree (preferred).
At least 3 years of behavioral health out‑of‑network billing experience.
Experience with CollaborateMD EMR and billing software.
Experience with ABA therapy (preferred).
Knowledge of CPT and ICD‑10 codes (preferred).
Claims denial experience with follow‑up from payers including appeals.
Benefits
21 paid days off (15 days PTO, increasing with tenure, plus 6 holidays).
Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
Medical, dental, vision, long‑term disability, and life insurance.
Generous 401(k) with up to 6% employer match.
Culture & Compliance Integrity, dependability, and attention to detail are the cornerstones of our team. We are a fast‑paced, growing company dedicated to enabling clients to spend more time helping people. Exact Billing Solutions participates in the U.S. Department of Homeland Security E‑Verify program.
Additional Information
Seniority Level: Associate
Employment Type: Full‑time
Job Function: Other
Industries: IT Services and IT Consulting
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About Exact Billing Solutions Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in substance use disorder, mental health, and autism care. With proprietary billing processes, deep industry knowledge, and a reputation for innovation, EBS helps partner healthcare companies streamline operations and accelerate cash flow. Company values: integrity, dependability, and attention to detail.
Role Overview As a Claims Resolution Specialist – Behavioral Health, you will coordinate with insurance companies and clients to secure maximum benefits. The role supports multiple expanding clinic locations; timely collections are critical to our operations and directly impact client families and children.
Key Responsibilities
Review and manage assigned accounts receivable inventory to ensure timely follow‑up on outstanding claims.
Investigate and resolve denials, rejections, and underpayments by working directly with payors and internal teams.
Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.
Document all collection activities clearly and accurately within our systems.
Monitor payor trends and elevate recurring issues to leadership.
Meet or exceed daily, weekly, and monthly productivity and quality standards.
Support special projects and process improvement initiatives as assigned.
Maintain effective communication with third‑party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction.
Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc.
Enter status claims and add notes in the patient accounting system (CollaborateMD).
Escalate any payor or client claim issues to department leadership.
Establish/maintain effective communications with the leadership team to ensure compliance with third‑party guidelines.
Update patient demographics and insurance information as needed.
Maintain productivity KPI metrics.
Requirements
Review and manage assigned AR inventory to ensure timely follow‑up on outstanding claims.
Investigate and resolve denials, rejections, and underpayments by working directly with payors, and internal teams.
Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.
Document all collection activities clearly and accurately within our systems.
Monitor payor trends and elevate recurring issues to leadership.
Meet or exceed daily, weekly, and monthly productivity and quality standards.
Support special projects and process improvement initiatives as assigned.
Maintain effective communication with third‑party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction.
Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc.
Enter status claims and add notes in the patient accounting system (CollaborateMD).
Escalate any payor or client claim issues to department leadership.
Establish/maintain effective communications with the leadership team to ensure compliance with third‑party guidelines.
Update patient demographics and insurance information as needed.
Maintain KPI metrics for productivity.
Qualifications
Associate’s degree (preferred).
At least 3 years of behavioral health out‑of‑network billing experience.
Experience with CollaborateMD EMR and billing software.
Experience with ABA therapy (preferred).
Knowledge of CPT and ICD‑10 codes (preferred).
Claims denial experience with follow‑up from payers including appeals.
Benefits
21 paid days off (15 days PTO, increasing with tenure, plus 6 holidays).
Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
Medical, dental, vision, long‑term disability, and life insurance.
Generous 401(k) with up to 6% employer match.
Culture & Compliance Integrity, dependability, and attention to detail are the cornerstones of our team. We are a fast‑paced, growing company dedicated to enabling clients to spend more time helping people. Exact Billing Solutions participates in the U.S. Department of Homeland Security E‑Verify program.
Additional Information
Seniority Level: Associate
Employment Type: Full‑time
Job Function: Other
Industries: IT Services and IT Consulting
#J-18808-Ljbffr