Billing Specialist

Role Description

We are seeking a compassionate and detail-oriented Billing Specialist to join our team, focusing on patient responsibility collections while maintaining KBH's commitment to supporting families throughout their ABA journey. This role combines insurance patient responsibility collections expertise with strong family advocacy, helping connect families with resources to cover treatment costs while ensuring strong billing processes. The ideal candidate is empathetic, organized, and skilled at building positive relationships with families during sensitive financial conversations. The Billing Specialist will serve as a bridge between our billing operations and the families we serve, always prioritizing the continued care and support of our clients, while ensuring complete and timely collections performance.

Qualifications

• 1-3 years of experience in healthcare billing/collections, health insurance interactions, or patient financial services
• Experience with insurance verification, claims processing, and accounts receivable
• Knowledge of healthcare billing regulations and HIPAA compliance requirements
• Strong customer service background with experience in sensitive financial conversations
• Excellent communication skills, both written and verbal
• Ability to resolve complex roadblocks independently and maintain diligent follow-up processes
• Willingness to go above and beyond to connect families with resources and help them navigate payment for services
• Familiarity with ABA Services preferred (CPT Codes View phone number on remotive.com) and Medicaid eligibility
• Familiarity with EHR systems (CentralReach preferred), and Microsoft Office Suite (Excel, Word, Outlook)
• Detail-oriented with strong organizational and time management skills
• Ability to work independently and manage multiple priorities in a fast-paced environment
• Familiarity working with both commercial insurance and government-funded (i.e., Medicaid and TRICARE) healthcare payors
• Demonstrated experience driving payor accountability – comfortable pushing on payors and advocating for insurance coverage and timely claims payment on behalf of clients
• Experience working with families or in pediatric, third-party reimbursed healthcare settings preferred

Requirements

• Manage patient responsibility accounts with kindness and professionalism
• Develop and maintain flexible payment plans tailored to each family's unique financial circumstances, while ensuring ongoing adherence to agreed upon plans
• Maintain detailed records of all collection activities, payment arrangements, and family communications
• Monitor A/R aging reports to prioritize collection efforts
• Process patient payments and apply them accurately to appropriate accounts and services
• Research and identify financial assistance programs, grants, and community resources offering financial support for families receiving autism services
• Proactively connect families with autism-specific funding organizations and state assistance programs, and nonprofit resources
• Maintain a comprehensive database of local and national resources for easy family referrals
• Create educational tools and step-by-step guides for families to independently and easily access available financial assistance programs
• Advocate for families during financial hardship by exploring all available support options
• Primary point of contact, managing relationship with third-party automated insurance verification partner
• Manage our automated insurance verification process using our third-party benefits verification platform for all new intake clients and ongoing verification for existing clients
• Review monthly eligibility checks to ensure continuous coverage and proactively identify policy changes
• Determine and communicate to families applicable ABA coverage limits and exclusions, deductibles, copayments, and authorization requirements
• Provide clear, understandable explanations to families about their insurance benefits, coverage details, and anticipated out-of-pocket costs based on verification results
• Maintain accurate and up-to-date insurance information in patient records and promptly update any changes identified
• When insurance changes occur, coordinate seamlessly across authorizations, scheduling, credentialing, and billing teams to ensure uninterrupted continuation of care
• Identify potential coverage gaps through platform reporting and work with families to secure alternative funding sources before service interruption
• Troubleshoot any platform issues and escalate complex verification cases to vendor support when needed
• Reprocess insurance claims when patient financial obligations have been incorrectly calculated or applied by insurance carriers
• Prepare and file formal appeals for incorrectly denied claims, including compilation and submission of supporting clinical documentation
• Track appeal outcomes and follow up on pending decisions within established timeframes
• Maintain detailed logs of all reprocessing activities and communicate outcomes to relevant stakeholders
• Complete Electronic Funds Transfer (EFT) enrollment applications for new insurance payors
• Set up Electronic Remittance Advice (ERA) enrollments to streamline payment processing and reconciliation
• Maintain current enrollment status for all active insurance contracts and renew as needed
• Proactively troubleshoot EFT and ERA processing issues and coordinate resolution with payor representatives
• Update banking and contact information for electronic payment systems as organizational changes occur

Benefits

• KBH is committed to creating a diverse environment and we are proud to be an equal opportunity employer.
• All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
• Diversity is more than a commitment at KBH- it is the foundation of what we do, adhering to the highest professional standards while creating an environment in which exceptional people (like you!) can think big, have fun, and do good.