Billing and Eligibility Specialist

Job Description

Job Description

Description:

About Envision Unlimited: Founded in 1948 in Chicago, Envision Unlimited provides a full spectrum of care for individuals with disabilities ranging in age from infancy to 80+. We serve all individuals regardless of race, gender, religion, or ability to pay. Our innovative services span Chicagoland and Central Illinois and include community living, day programs, behavioral health, employment services, family respite, and foster care. Our innovative services span Chicagoland and Central Illinois and include community living, day programs, behavioral health, employment services, family respite, foster care and Supportive Housing.

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Summary:

The Billing and Eligibility Specialist is responsible for managing critical aspects of the revenue cycle, including client eligibility monitoring, financial registration, prior authorizations, claims management, and other general RCM duties. This position plays a critical role in protecting organizational revenue by ensuring accurate and continuous patient insurance coverage, with a primary focus on Medicaid eligibility management. This role combines traditional billing functions with proactive eligibility monitoring, working to prevent revenue loss associated with coverage gaps, policy changes, and increased Medicaid redetermination requirements. This position serves as a key liaison between front-end operations, clinical teams, and the revenue cycle department to identify and resolve coverage issues before, during, and after service delivery. A strong understanding of billing processes, insurance policies, and collections procedures is essential to this role, along with a keen ability to improve processes and maintain compliance with healthcare regulations.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Essential Responsibilities, include but are not limited to:

Eligibility & Coverage Management

• Perform daily eligibility verification for scheduled patients, including batch and real-time checks
• Monitor and track patients at risk of losing Medicaid coverage
• Investigate and resolve eligibility discrepancies, including terminations, pending renewals, and MCO assignment issues
• Collaborate with front desk and clinical staff to address eligibility issues prior to service delivery
• Assist patients and/or staff with Medicaid renewal processes and documentation requirements
• Maintain tracking logs for at-risk and inactive patients, including follow-up actions and outcomes
• Participate in process improvement initiatives to strengthen front-end revenue cycle performance
• Support training efforts related to eligibility verification and documentation requirements

Financial Registrar

• Assist the Intake Department by registering new clients and ensuring accurate financial information is captured.
• Help clients and staff with applying for the Sliding Fee Discount Program.
• Update client financial records when insurance changes occur, ensuring accurate documentation and compliance.
• Manage Registrations with the IL Mental Health Collaborative by registering new Medicaid clients, re-registering existing clients, and closing registrations for discharged clients

Collections & Payment Follow-Up

• Generate client statements for those with outstanding balances or Medicaid Spenddown requirements.
• Follow up on overdue accounts, sending reminders and contacting clients to ensure timely payment.
• Establish and manage payment plans for clients with outstanding balances.
• Communicate with health care providers, clients, insurance claim representatives, and other parties to clarify billing issues and facilitate timely payment.

Billing & Revenue Cycle Functions

• Submit and monitor claims for accuracy and timeliness
• Conduct pre-bill eligibility checks to ensure claims are submitted only for active coverage periods
• Identify and hold claims with eligibility concerns for further review
• Post payments and assist with reconciliation processes as needed

Denial Management & AR Follow-Up

• Work eligibility-related denials, including “coverage terminated,” “member not eligible,” and similar issues 3
• Research and resolve denied claims through re-verification, payer outreach, and resubmission
• Track trends in eligibility-related denials and report findings to leadership
• Assist with recovery of revenue through retroactive eligibility verification when applicable

Contracting & Credentialing

• Assist Director with managing the contracting process to ensure providers are in network with insurance companies, MCOs and Medicare
• Coordinate with payers and leadership to finalize contracts, ensuring timely execution.
• Oversee the credentialing process, ensuring all required staff documentation (e.g., licenses, certifications) is up to date.
• Submit credentialing applications to insurance companies, track approval status, and resolve any issues promptly.
• Maintain accurate records of credentialing documents to ensure compliance.
• Perform other related duties and/or projects as assigned

SUPERVISORY RESPONSIBILITIES

None

OVERALL JOB PERFORMANCE:

• This position is hybrid, requiring both on-site presence and the option for remote work. The exact schedule will be determined in coordination with the Director of Revenue Cycle Management and any on-site requirements the department may need to fulfill. The schedule can change at any given time, but staff will be provided ample time for planning.
• Perform duties and functions in accordance with all agency policies.
• Maintain a professional attitude in conduct and in interactions with other staff, clients, and outside personnel.
• Maintain a clean and neat appearance and follow Envision Unlimited's dress code.
• At all times, maintain confidentiality according to the Illinois Mental Health Code and Confidentiality Act.
• Demonstrate conduct and behaviors consistent with agency mission and policies.
• At all times, maintain a professional image and role as a representative of Envision Unlimited.
• Adhere to all the Policies and Procedures of Envision Unlimited.
• Respond sensitively to the diverse populations of the agency, including people with disabilities and/or mental health issues.
• Attend all meetings and training courses as requested by the Director and/or supervisor.
• Arrive at work, meetings, and all work-related functions on time. Report any absence, tardiness, or schedule change to the supervisor as soon as possible. Maintain an appropriate attendance record using Paylocity.

OTHER EXPECTATION

Employees shall respect the diversity of all individuals (e.g., clients, co-workers, stakeholders) and refrain from any form of discrimination and/or based upon a person’s legally protected characteristics or conduct, including but not limited to race, color, religion, sex, national origin, age, disability, sexual orientation, and gender identity or expression.

Employees share the responsibility of creating and maintaining a welcoming, supportive, and inclusive work environment.

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and/or skills required of all employees so classified.

Requirements:

QUALIFICATIONS

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.

EDUCATION, SKILLS, and/or EXPERIENCE

Minimum Qualifications:

High school diploma or equivalent. Associate or bachelor’s degree preferred.

Minimum 2 years of experience in the healthcare industry, working with Medicaid, Medicare, Commercial Insurance, and/or Managed Care Organizations. Knowledge of eligibility verification processes, insurance portals, and clearinghouses. One to three years of training and experience in Revenue Cycle functions highly preferred. Educated in and compliant with HIPAA regulations. Understand medical terminology and maintain strict confidentiality of client and client information. Strong understanding of Microsoft applications, i.e. Excel, Outlook, and Word. Experience working with Electronic Health Records Systems. Ability to investigate problems and develop/communicate solutions. Professional communication with staff and clients.

Envision Unlimited offers competitive salaries and a generous benefit package to our professionals

Blue Cross/Blue Shield Medical Coverage: HMO, PPO

Dental and Vision Insurance Options

Company paid Life and LTD Insurance

Voluntary plans (Pet insurance, AD&D, Life, Critical Illness, Short Term Disability)

11 Paid Holidays

Paid vacation, sick time and personal days

403B plan

In house training and CEU’s

Employee Assistance Network

Support for pursuing clinical licensure (financial and time off)

Opportunity for career growth & development