Claims Resolution Specialist

Claims Resolution Specialist - Behavioral Health – Exact Billing Solutions (EBS) Lauderdale Lakes, FL About the Role We are looking for an experienced behavioral health collections professional to handle claims resolution and ensure maximum benefits for our clients. The role involves working with multiple clinic locations, communicating with insurance companies, and maintaining accurate collections records. 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 escalate 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 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). 3 years of experience in behavioral health out‑of‑network billing. Knowledge and experience with CollaborateMD EMR and billing software programs. Experience with ABA therapy preferred. Experience/knowledge with CPT and ICD‑10 codes preferred. Claims denial experience with follow‑up from payers including appeals. Benefits 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. Culture Integrity. Dependability. Attention to detail. All our team members exhibit these qualities when it comes to doing business. 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. #J-18808-Ljbffr