Collections Specialist - Substance Abuse Treatment Operations (47578)

Job Details Location: Boynton Beach, FL 33426 Position Type: Full Time Salary Range: $27.00 - $30.00 Hourly Position Summary We are seeking a diligent and detail-oriented Collections Specialist to join our revenue cycle team. In this role, you won't just be processing payments; you will be a vital link in ensuring our facility remains sustainable so we can continue providing life-saving care. You will manage the full lifecycle of patient accounts, from identifying delinquent insurance claims to negotiating payment plans with families during vulnerable times. Key Responsibilities Identify and resolve unpaid claims by analyzing EOBs and remittance advice to ensure the maximum allowable insurance payment is recovered before billing the patient. Draft and submit formal appeals for "medical necessity" denials, leveraging ASAM/DSM-5 criteria to advocate for payment of the full length of stay. Aggressively manage the Accounts Receivable aging report, prioritizing high-dollar claims over 30 days to minimize "bad debt" and optimize cash flow. Audit initial Verification of Benefits (VOB) against actual claim payouts to explain "patient responsibility" (deductibles/co-insurance) clearly and accurately to families. Perform necessary data entry and coding corrections (ICD-10, HCPCS, CPT) to facilitate immediate "clean claim" re-submission and faster reimbursement. Investigate and resolve primary/secondary payer conflicts to eliminate "patient-due" balances caused by insurance liability errors. Cross-reference billed dates against Utilization Review (UR) authorizations to ensure all billable days are covered and collectible. Stay current on evolving behavioral health medical policies and the Mental Health Parity and Addiction Equity Act (MHPAEA) to challenge unfair payer practices. Monitor insurance payments against contracted rates to identify, dispute, and collect on underpaid claims. Identify overpayments and process insurance or patient refunds/offsets in strict accordance with compliance standards. Ensure all collection communications—whether with payers or patients—adhere to HIPAA and FDCPA (Fair Debt Collection Practices Act) standards. Provide management with weekly collection reports, highlighting payer behavior patterns and identifying trends in high-volume denial reasons. Qualifications & Competencies Familiarity with regulatory requirements: NJ: NJAC 10:161A/B – Billing compliance for SUD facilities, FL: FAC 65D-30 – Billing documentation and reporting requirements, CA: Title 9 CCR, Chapter 11 – SUD billing and recordkeeping Exceptional attention to detail and an eye for spotting errors and discrepancies. Strong communication and customer service skills with the ability to see issues through to resolution. Intermediate to advanced levels of skills in Google Suite and/or Microsoft Office and a proven aptitude for computers. Strong understanding of current ICD-10, CPT and HCPCS coding practices. Preferred understanding of ASAM (American Society of Addiction Medicine) criteria and how it relates to billing levels of care. Experience with Kipu and CollaborateMD. Familiarity with HIPAA privacy laws and the Mental Health Parity and Addiction Equity Act (MHPAEA). #J-18808-Ljbffr