Billing Specialist

Billing Specialist

The Billing Specialist is responsible for managing the full revenue cycle for substance use disorder (SUD) and behavioral health services in the 1525 Marion Barry Avenue programs, including claims submission, payment posting, denial management, and account reconciliation. Utilizing eClinicalWorks (eCW), the Billing Specialist ensures timely and accurate billing to Medicaid, Medicare, and third-party payers in accordance with DC Department of Behavioral Health (DBH) requirements and applicable Federal and District regulations. The role requires close collaboration with clinical and administrative staff to support accurate documentation, authorization, and reimbursement of services.

Duties and responsibilities include:

• Prepares, reviews, and submits accurate claims for SUD and behavioral health services to Medicaid, Medicare, and third-party payers using eClinicalWorks (eCW).
• Verifies client Medicaid, Medicare, and third-party insurance eligibility, and confirms authorization requirements prior to and during treatment.
• Posts payments, adjustments, and denials accurately and in a timely manner, and reconciles accounts receivable within eCW.
• Identifies, researches, and resolves claim denials and rejections, including timely resubmission or appeal of denied claims.
• Monitors claims audit error rates and works to keep them within Department of Behavioral Health (DBH) certification standards.
• Coordinates with clinical staff to ensure documentation supports billed services and complies with DBH, Medicaid, and other payer requirements.
• Generates and reviews billing reports, aging reports, and revenue cycle metrics for leadership, identifying trends and areas for improvement.
• Maintains compliance with 42 CFR Part 2, HIPAA, and other Federal and District confidentiality regulations when handling client billing information.
• Works closely with the finance and clinical teams to support accurate revenue reporting and resolve billing-related client or provider inquiries.

Experience and qualifications include:

• High school diploma or GED preferred; Associate's or Bachelor's degree in healthcare administration, accounting, business, or related field preferred.
• 2+ years of medical billing experience required, with direct experience in DC behavioral health or substance use disorder (SUD) billing strongly preferred.
• Hands-on experience with eClinicalWorks (eCW) required, including claims submission, payment posting, and reporting modules.
• Familiarity with DC Department of Behavioral Health (DBH) certification standards, Medicaid billing requirements, and 42 CFR Part 2 confidentiality regulations.
• Proficiency in MS Office applications (Word, Outlook, Excel, Adobe) and various business software.
• Legally authorized to work in the U.S.A.

Competencies include:

1. Accuracy and attention to detail; ensures claims, payments, and account records are entered and reconciled correctly to minimize denials and audit findings.
2. Regulatory and payer knowledge; stays current on DBH, Medicaid, and other payer billing rules to keep claims and documentation compliant.
3. Problem-solving and follow-through; investigates denials and billing discrepancies, and drives them to resolution rather than letting them linger.
4. Technology proficiency; works efficiently within eClinicalWorks and other billing systems, and adapts quickly to system updates or new workflows.
5. Confidentiality and professionalism; handles sensitive client and financial information in accordance with 42 CFR Part 2, HIPAA, and organizational policy.

AAP/EEO STATEMENT:

It is the policy of Prestige Healthcare Resources, Inc. to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Prestige Healthcare Resources, Inc. will provide reasonable accommodation for qualified individuals with disabilities.