Administrative / Billing Specialist

Job Description

Job Description

The Administrative / Billing Specialist supports basic medical billing functions for a Counseling and Case Management agency, with entry-level exposure to counseling, case management coordination, opioid abatement support, and commercial health care credentialing. This role includes front-desk reception duties as needed and is suitable for individuals building experience in billing and care coordination.

Key goals:

• Ensure accurate, timely submission of eligible institutional claims (UB-04/CMS-1450) within an entry-level scope.
• Maintain orderly accounts receivable data and support routine payment posting.
• Assist with credentialing-related tasks and basic care coordination support under supervision.

ESSENTIAL RESPONSIBILITIES AND DUTIES

• Prepare, review, and submit basic institutional claims (UB-04/CMS-1450) to Medicare, Medicaid, and commercial payers via electronic submission under supervision.
• Perform daily payment posting and basic AR aging updates; assist with reconciliation as directed.
• Research and resubmit simple denied/rejected claims; escalate complex denials to more senior staff.
• Provide entry-level case management coordination tasks as directed, focusing on identifying patient needs and facilitating access to services.
• Support opioid abatement efforts by documenting needs and coordinating with care teams, under supervision, ensuring appropriate coding where applicable.
• Assist with eligibility and authorization data gathering; collaborate with Clinical Documentation to support billed services as directed.
• Collect and relay information for care coordination meetings and discharge planning as assigned.
• Ensure compliance with CMS, state Medicaid, and commercial payer guidelines for routine claims; escalate potential compliance issues to supervisor.
• Maintain awareness of current billing rules at a high level (basic revenue codes) and apply them within defined parameters.
• Perform other administrative tasks and special projects as assigned.
• ADDITIONAL RELEVANT DUTIES
• Serve as a frontline receptionist as needed, including:
  Greeting visitors, answering calls, and routing inquiries.
  Scheduling basic appointments and maintaining a clean reception area.
  
• Support cross-functional communication with Billing, Intake, Clinical Documentation, and Administration at a basic level.

QUALIFICATIONS & REQUIREMENTS

• Typically 0–2 years of healthcare medical billing experience; exposure to Counseling or medical billing preferred but not required.
  Basic familiarity with ICD-10/CPT codes and institutional claim forms (UB-04/CMS-1450) is helpful.
  Interest or exposure to counseling, case management, opioid abatement, or credentialing support is a plus.
  Proficiency with basic computer systems; willingness to learn EHR/billing software.
  Strong attention to detail, organizational skills, and professional communication.

PREFERRED KNOWLEDGE AND SKILLS

• Associate’s degree or equivalent in a related field (healthcare administration, business) preferred.
  Interest in medical billing, credentialing processes, or social services support.
  Strong communication and teamwork abilities.
  High level of professionalism and integrity with regulatory compliance awareness.

SUPERVISORY RESPONSIBILITIES

None.