Claims Resolution Specialist

Claims Resolution Specialist - Behavioral Health – Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental health, and autism care fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies. EBS is poised for exponential growth, and we are building out our teams to support the expansion of global operations. Part of the ICBD family office portfolio, Exact Billing Solutions combines entrepreneurial speed with the financial discipline of a self-funded, founder-led organization. Our growth reflects a proven ability to solve complex healthcare challenges with operational precision, scalable systems, and client-first innovation. Our Origin Story Exact Billing Solutions was launched to address one of healthcare’s most persistent challenges: the burden of billing and insurance administration on providers. With firsthand knowledge of how inefficiencies in revenue cycle management drain resources from patient care, our founder built a company dedicated to removing obstacles, accelerating cash flow, and delivering peace of mind to clients across specialties. Recognition & Awards Inc. 5000, 2024– Top 5 Fastest-Growing Private Companies in America (ABA Centers of America) EY Entrepreneur Of The Year®U.S. Overall Florida Trend Magazine– 500 Most Influential Business Leaders About the Role Are you an experienced behavioral health collections professional ready to take your career to the next level with a growing, fast-moving company? You could be our Claims Resolution Specialist—Behavioral Health, responsible for effective communication and coordination with insurance companies and clients to obtain the maximum benefits for clients. We work with multiple expanding clinic locations, so timely collections are critical to our operations. The work you will do can make a real difference in the lives of client families and kids by allowing our partners to open clinics where they are desperately needed. 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. Status claims and add notes in the patient accounting system (CollaborateMD). Escalate any payor or client claim issues to department leadership. Establish/maintain effective communication with the leadership team to ensure that all third-party guidelines are satisfied. Update patient demographics and insurance information as needed. Ability to meet KPI established metrics for productivity. Qualifications Associate's degree (preferred) Behavioral health out-of-network billing: 3 years of experience Knowledge and experience with CollaborateMD EMR and billing software programs Experience with ABA therapy preferred Experience/knowledge with CPT and ICD10 codes preferred Claims denial experience with follow up from payers including appeals 21 paid days off (15 days of PTO, which increases 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. Exact Billing Solutions (EBS) Culture Integrity. Dependability. Attention to detail. All our team members exhibit these qualities when it comes to doing business. And when it comes to the business of supporting a team, as a company, we offer no less to our team members. We’re a fast-paced, growing company delivering services that allow our clients to spend more time helping people. At the end of the day, it’s people, not numbers, that drive our success. Exact Billing Solutions participates in the U.S. Department of Homeland Security E-Verify program. #J-18808-Ljbffr ICBD