Billing Specialist

Job Description

Job Description

Burlington Pediatrics is seeking an experienced and detail-oriented Billing Specialist – Medical & Integrated Care to join our billing team.

This position will have primary responsibility for medical insurance billing, payment posting, and insurance follow-up, with a strong focus on Aetna, CHAMPVA, MedCost, and TRICARE. The Billing Specialist will also serve as an internal Integrated Care resource for mental and behavioral health eligibility and benefits escalation, and prior authorization requirements.

Medical Insurance Billing & Follow-Up

• Manage medical claims for Aetna, CHAMPVA, MedCost, and TRICARE.
• Verify insurance eligibility, benefits, deductibles, copays, coinsurance, and coverage limitations.
• Research and resolve claim rejections, denials, and underpayments.
• Submit corrected claims, reconsiderations, and appeals.
• Monitor claims for timely filing and proper reimbursement.
• Follow up with insurance companies on outstanding claims and accounts receivable.
Insurance Payment Posting
• Post insurance payments, contractual adjustments, denials, and patient responsibility accurately.
• Review EOBs, ERAs, and remittance information for accuracy.
• Identify incorrect payments, missing payments, and underpayments.
• Research discrepancies between payments received and expected reimbursement.
• Ensure payments and adjustments are posted to the appropriate patient accounts and dates of service.
• Identify recurring payment or reimbursement issues and communicate trends to management.

Integrated Care – Mental & Behavioral Health Resource

• Serve as the escalation resource for mental and behavioral health eligibility and benefits questions.
• Research behavioral health coverage, copays, deductibles, coinsurance, visit limits, and exclusions.
• Determine whether mental and behavioral health services require prior authorization or referrals.
• Obtain and track behavioral health prior authorizations.
• Research payerspecific requirements for psychotherapy, nutritional, behavioral health, integrated care, and telehealth services.
• Assist staff with complex behavioral health insurance questions and billing issues.
• Communicate insurance requirements clearly to providers, clinical staff, frontoffice staff, and the billing team.
Prior Authorizations
• Obtain and track medical and behavioral health authorizations.
• Monitor authorization numbers, effective dates, approved services, and visit limits.
• Follow up on pending or denied authorization requests.
• Research authorizationrelated claim denials and determine appropriate resolution.
Qualifications
• Minimum 2 years of medical billing experience.
• Strong experience with insurance eligibility, benefits, claims, payment posting, and A/R.
• Experience with Aetna, CHAMPVA, MedCost, and TRICARE strongly preferred.
• Behavioral/mental health billing experience strongly preferred.
• Experience with NC Medicaid and commercial insurance.
• Experience with prior authorizations, denials, appeals, and corrected claims.
• Knowledge of CPT, HCPCS, ICD10, modifiers, and place of service codes.
• Strong attention to detail and organizational skills.
• Excellent problemsolving and criticalthinking abilities.
• Strong written and verbal communication skills.
• Ability to manage a high volume of claims and payments while maintaining accuracy.

Pediatric billing experience, behavioral/mental health billing experience, and Office Practicum experience are a plus.