Billing Specialist

Wayside Youth And Family Support Network Billing Specialist

Show your passion by empowering youth and families when joining the Wayside team! Wayside is one of Massachusetts' most respected youth and family-serving agencies, supporting more than 6,000 youth and families annually across Central, Eastern, and Northeastern regions. We invest in our employees' wellness with comprehensive benefits, including tuition and training reimbursement, a PTO package with 3 wellness days, 9 paid holidays, and up to 3 weeks of vacation in the first year. Enjoy a learning environment with free training, CEUs, and more, along with exceptional medical benefits, financial health supports, and career development opportunities. Apply today and earn a $2,000.00 sign-on bonus (pro-rated for part-time)!

Framingham, MA

Wayside Youth and Family Support Network is looking for a highly organized detail oriented Billing Specialist to manage billing operations for children's behavioral health services. The Billing Specialist reports to the Director of Revenue and is responsible for full-cycle medical billing, including claim submission, claim denials, payment posting, and accounts receivable oversight. The individual in this role will ensure accurate and timely reimbursement, maintain clean accounts receivable (AR) balances, monitor claim trends, and ensure compliance with agency and payer requirements, including MassHealth, Medicaid, and commercial insurers. The Billing Specialist will develop a comprehensive understanding of billing regulations and payer guidelines, resolve complex claims issues, and provide accurate financial data to program directors and senior staff on an ongoing basis. This position requires proactive problem-solving, high attention to detail, the ability to work independently or cross functionally with clinical, administrative, and finance teams. The candidate must have strong communication and collaboration skills and will be accountable for following through on matters to ensure timely resolution.

Salary Range: $21.63 - $28.85/hour based on experience + sign - on bonus (half paid after 6 months of employment and half paid after 1 year of employment/pro-rated for part-time).

This is a Full-Time position, 40 hours/week, Hybrid schedule (minimum 3 days in office).

Job Responsibilities:

• Perform full-cycle billing functions for children's behavioral health services, managing complex claims with a high level of accuracy and efficiency.
• Manage the daily submission of high-volume primary and secondary claims, ensuring compliance with payer requirements.
• Verify and validate all claim data, including provider information, member eligibility, filing limits, and coding for HCPCS, CPT, diagnoses, and procedures.
• Effectively validate claim acceptance to ensure successful submission and timely reimbursement.
• Apply in-depth knowledge of payer requirements, including MassHealth/Medicaid, commercial insurers, and coordination of benefits (COB).
• Proactively manage denied and rejected claims by researching, reviewing, correcting, and appealing complex or escalated issues to ensure timely resolution.
• Prevent recurring errors and maintain clear communication with insurance companies and families throughout the resolution process.
• Utilize billing systems, including EDI, clearinghouses, CMS-1500/UB forms, and EHR platforms, to ensure accurate claim submission and tracking.
• Monitor billing workflows for problems, such as claims not processing correctly or a high volume of outstanding accounts receivable and take appropriate corrective action.
• Generate client statements, conduct collection follow-ups, and process invoices as needed to maintain clean accounts receivable balances.
• Collaborate with internal teams to resolve billing discrepancies and improve claim accuracy at the source, supporting workflow efficiency and process improvement initiatives.
• Support other billing and revenue cycle tasks as assigned, contributing to overall organizational financial performance.

Competencies:

• Strong attention to detail, with the ability to accurately review and resolve complex billing discrepancies.
• Advanced problem-solving and analytical skills, particularly in resolving denials, rejections, and accounts receivable issues.
• Excellent organizational and time-management skills in a fast-paced, high-volume environment.
• Effective verbal and written communication, with the ability to collaborate with internal teams, payers, and families.
• Ability to work independently, taking ownership of tasks and following through to completion.
• Strong prioritization and multitasking abilities while managing concurrent deadlines and processing a high volume of claims efficiently.
• Proficiency in Excel and billing/reporting systems, with the ability to analyze data and support process improvements.
• In-depth knowledge of MassHealth, behavioral health billing, and revenue cycle processes, ensuring compliance and accurate reimbursement.
• Experience with Qualifacts Carelogic and Inovalon clearinghouse systems preferred, with the ability to apply system functionality for accurate claims management and reporting

Minimum Requirements:

• Associate's or bachelor's degree in healthcare administration, finance, business, or related field (or equivalent experience).
• 4+ years of experience in medical billing or revenue cycle management, including third-party billing, preferably in behavioral or mental health.
• Strong knowledge of payer requirements (MassHealth/Medicaid, commercial insurers, COB) and claims lifecycle management (submissions, denials, appeals, reimbursement).
• Experience with Qualifacts Carelogic and Inovalon clearinghouse systems preferred.