About this role
Key Responsibilities
- Submit ABA authorization requests and extension requests to insurance companies.
- Follow up with insurance case coordinators, including BCBS Illinois and other payors, regarding pending authorization requests.
- Audit clinical packets, supporting documentation, and assessments required for authorization approvals.
- Track authorization due dates and renewal timelines using Monday.com and other tracking systems.
- Support the development and submission of authorization appeals when services are denied or reduced.
- Review, scrub, and submit electronic and paper claims for ABA and therapy services.
- Research and resolve claim rejections, denials, and payment delays.
- Investigate payer-specific billing issues and implement corrective actions.
- Manage claim aging reports and follow up on outstanding accounts receivable balances for all disciplines.
- Write and submit claims appealing to recover denied reimbursement.
- Verify insurance eligibility, benefits, authorizations, and coverage requirements, primarily for ABA services.
- Document benefit information, authorization requirements, and payer communications in Central Reach.
- Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
- Post payments accurately and reconcile insurance payments.
- Identify denial trends and develop action plans for resolution.
- Complete Work-In-Progress (WIP) documentation by recording ERA dates, payment amounts, adjustments, and write-offs.
- Process and monitor secondary insurance billing for all disciplines.
- Track recoupments and overpayment requests received by mail and electronically, ensuring validity before repayment.
- Maintain detailed documentation of insurance calls, payer correspondence, and critical communications within Central Reach.
- Respond promptly to Teams messages, emails, and internal requests.
- Open and review insurance correspondence, identifying denials, requests for records, and reimbursement issues.
- Collaborate with clinical, scheduling, and leadership teams to resolve billing and authorization concerns.
- Monitor clean claim ratios and claim generation accuracy.
- Recommend process improvements to enhance reimbursement rates and operational efficiency.
Education
- Associate's or bachelor’s degree in healthcare administration, Business, Accounting, or related field is required.
Experience
- Minimum 3 to 5 years of medical billing, insurance authorization, or revenue cycle experience.
- Prior experience with ABA billing and pediatric therapy services in behavioral health strongly preferred.
- Proven experience managing insurance denials, appeals, and authorizations.
- Proficiency with Central Reach or similar practice management systems.
- Experience with insurance clearinghouses and claims management platforms.
- Strong Microsoft 365 skills, including Excel, Outlook, Teams, and Word.
- Knowledge of Medicaid, Medicare, BCBS, and commercial insurance plans.
- Experience preparing authorization and claims appeals.
- Ability to communicate effectively via phone, email, and virtual platforms.
- Ability to manage detailed administrative work with a high level of accuracy.
Knowledge & Competencies
- Strong understanding of insurance billing processes, EOB interpretation, and revenue cycle management.
- Familiarity with payer requirements, authorization procedures, and pediatric therapy reimbursement guidelines.
- Excellent written and verbal communication skills.
- Strong organizational and time management abilities.
- Ability to manage multiple priorities while maintaining accuracy and compliance.
- Demonstrated problem-solving and analytical skills.