Medical Billing & Accounting Specialist

Job Description

Job Description

Position Overview:  

The Billing Specialist & Senior Accountant supports the organization’s accounting functions and provides financial oversight of behavioral health claims revenue and reimbursement. This position serves as the primary Finance liaison with the billing partner, monitoring claims activity, payment reconciliation, accounts receivable, and billing discrepancies. The role also supports monthly close, account reconciliations, general ledger accuracy, and other accounting and reimbursement functions.

Accounting Responsibilities  

• Prepare journal entries and assist with monthly and year-end close activities. 

• Reconcile bank accounts, credit cards, claims receivable accounts, and other balance sheet accounts. 

• Maintain accounting schedules including prepaid expenses, accrued liabilities, fixed assets, depreciation, grants, and restricted funds. 

• Review general ledger activity for accuracy, identify discrepancies, and research and resolve accounting issues.
• Assist with grant invoicing, county board billing, and other reimbursement-related processes. 

• Support annual audits, grant reporting, and other financial reviews by preparing schedules and requested documentation. 
• Assist with maintaining appropriate internal controls and identifying opportunities to strengthen accounting processes.

Claims Revenue & Billing Oversight Responsibilities  

• Serve as the primary Finance liaison with Emerge's external billing partner.
• Reconcile claims activity to payments received, including unapplied payments, recoupments, adjustments, and other discrepancies, and coordinate resolution with the billing partner.
• Monitor and reconcile claim revenue and accounts receivable to ensure billed, collected, outstanding, and unbilled amounts are accurately reflected and supported.

• Assist with claim corrections, rebilling efforts, payment research, and reimbursement follow-up. 
• Review billing and reimbursement trends and identify significant changes, recurring issues, or areas requiring additional follow-up.
• Track outstanding billing issues and hold the external billing partner accountable for timely follow-up and resolution.
• Assist Finance leadership with forecasting and reporting claims revenue and accounts receivable.
• Maintain sufficient documentation to support claims revenue, payment application, accounts receivable balances, and related reconciliations.
• Maintain knowledge of Medicaid, managed care, and behavioral health reimbursement requirements necessary to effectively oversee and evaluate billing activity. General Responsibilities 

• Maintain organized financial and billing records and assist with process improvement initiatives. 

• Adhere to all organizational and departmental policies and procedures, including compliance with all behavioral, ethical, and client boundary expectations 

• Maintain organization, Ohio MHAS, and CARF required training 

• Maintain license or registration appropriate to profession and appropriate to job requirement, including appropriate amount of continuing education at all times of employment 

• Maintain strict confidentiality at all times 

• Other duties as assigned 

Required Knowledge, Abilities, and Working Conditions  

Knowledge: 

• Strong knowledge of generally accepted accounting principles and general ledger accounting.
• Working knowledge of month-end close, journal entries, accrual accounting, account reconciliations, and balance sheet account management.
• Strong understanding of accounts receivable, revenue recognition, payment application, and reconciliation processes.
• Strong working knowledge of healthcare revenue cycle processes and the lifecycle of a medical claim from service and billing through adjudication, payment, denial, and follow-up.
• Knowledge of Medicaid and managed care reimbursement processes; behavioral health billing experience strongly preferred.
• Understanding of claims receivable, remittance advice, explanations of benefits, denials, adjustments, recoupments, and payment posting.
• Knowledge of financial controls related to outsourced billing and reimbursement functions.
• Knowledge of nonprofit accounting and financial operations preferred.
• Advanced working knowledge of Microsoft Excel and accounting systems.
• Familiarity with QuickBooks Online, electronic health records, clearinghouses, and healthcare billing platforms preferred.

Skills:

• Strong accounting, reconciliation, and analytical skills.
• Ability to reconcile complex claims and financial information across billing systems, bank activity, and accounting records.
• Ability to analyze A/R aging and claims activity and identify unusual balances, trends, and discrepancies requiring investigation.
• Ability to evaluate reports produced by an external billing partner and determine whether the information is complete, reasonable, and reconcilable.
• Strong attention to detail and a high degree of accuracy.
• Strong Excel skills, including the ability to organize, analyze, reconcile, and validate large data sets.
• Strong problem-solving and research skills with the ability to independently follow discrepancies through resolution.
• Ability to effectively communicate questions, discrepancies, expectations, and required follow-up to external billing partners and internal staff.
• Strong organizational and time-management skills with the ability to manage multiple deadlines and competing priorities.
• Ability to maintain confidentiality and appropriately handle sensitive financial and client information.

Abilities:

• Independently perform complex account and claims revenue reconciliations.
• Analyze claims and reimbursement information and reconcile activity between billing systems, remittance information, bank deposits, and the general ledger.
• Evaluate accounts receivable and determine whether reported balances are adequately supported.
• Identify gaps between services provided, claims billed, payments received, and amounts remaining outstanding or unbilled.
• Provide effective financial oversight of an outsourced billing function without performing the external billing partner's day-to-day responsibilities.
• Identify issues requiring escalation and ensure appropriate follow-up occurs.
• Exercise sound judgment when researching complex accounting and reimbursement issues.
• Work independently while collaborating effectively with Finance leadership, internal departments, billing vendors, auditors, payers, and funding entities.
• Adapt to changing Medicaid, managed care, and behavioral health reimbursement requirements.
• Identify opportunities to strengthen accounting, claims reconciliation, billing oversight, and revenue cycle processes.

Qualifications and Education Requirements   

• Bachelor's degree in Accounting, Finance, Business, or related field; or equivalent combination of education and experience. 

• Two (2) years of experience in accounting, bookkeeping, billing, reimbursement, or related financial functions. 

• Demonstrated ability to manage multiple priorities and meet deadlines. 

• Experience with Non-Profit, Medicaid or healthcare claims billing and reimbursement; behavioral health billing experience strongly preferred.

• Experience with QuickBooks Online, electronic health records, or healthcare billing platforms. 
• Experience supporting month-end close and financial reporting processes.