Third Party Billing Specialist - Administration

Job Description

Job Description

Description:

The Third Party Billing Specialist is a key member of the Billing Department, responsible for ensuring the accurate submission and timely collection of insurance and self-pay receivables across a diverse payer mix. This role serves as the primary liaison between the organization and third-party payers, including MassHealth, MassHealth MCOs, Medicare and Medicare MCOs, and commercial payers, candidate must possess a thorough working knowledge of mental health and/or medical billing regulations and payer requirements.

Core responsibilities encompass the full revenue cycle: obtaining prior authorizations, verifying insurance coverage, submitting clean claims in a timely manner, and resolving pre-billing and daily claim rejections. The Specialist monitors both insurance and self-pay aging reports to identify reimbursement trends and address outstanding balances, while maintaining accurate daily payment posting for client and insurance payments. Client data integrity is upheld through diligent entry and maintenance of records within the electronic billing system.

The ideal candidate brings a minimum of 2 – 3 years of experience in mental health or medical billing and third-party accounts receivable management, along with proficiency in Microsoft Office applications. Strong attention to detail, the ability to prioritize in a fast-paced environment, and a commitment to remaining current with evolving billing rules and regulations are essential to success in this role. The Specialist is expected to adhere to established organizational procedures and protocols and to operate within appropriate reporting structures at all times.

In addition to very competitive salaries LUK offers a substantial and unique benefit package found here .

Introduction to LUK, Inc.

LUK has deep roots in Central Massachusetts. We’re driven by our values and we’re serious about our work. It’s not easy work, but it is rewarding! With Crisis as our middle name (LUK Crisis Center), we are well versed in handling all kinds of issues that may arise. LUK exists to help people thrive – the people we serve and the people who work here. We appreciate creative thinking, uniqueness, and tenacity. We encourage staff to participate in numerous opportunities to grow as an individual and a member of a team, influence others and be influenced, be your best and do your best. We provide individualized services to the people we work with and offer flexibility so that staff can meet responsibilities at work and outside of work. The community is “LUK-y” to have the skills, experience, and talent of our staff!

For more information, please visit our website & social media accounts!

Website | Facebook | Instagram | YouTube | LinkedIn

Purpose

The Third Party Billing Specialist supports the financial operations of the organization by managing the full cycle of third-party billing and accounts receivable. This role ensures accurate and timely claims submission, payment posting, and collections across multiple payer types

Responsibilities Include

• Serve as liaison to third-party payers including MassHealth, MassHealth MCOs, Medicare, Medicare MCOs, and commercial payers
• Obtain and manage prior authorizations from third-party payers
• Conduct insurance coverage verifications for clients
• Submit claims accurately and within required timeframes
• Identify and resolve pre-billing errors prior to claim submission
• Review and resolve daily claim rejections in a timely manner
• Monitor insurance accounts receivable for reimbursement error trends
• Manage and work the insurance aging report to ensure timely collections
• Manage and work the self-pay collections aging report
• Process daily payment posting for both client and insurance payments
• Ensure accuracy and timeliness of all payment entries in the billing system
• Work directly with clients on billing-related tasks as needed
• Enter and maintain accurate client information in the electronic billing software
• Provide general administrative support to the billing department as needed
• Adhere to all organizational procedures, protocols, and chain of command
• Remain current with billing rules, regulations, and payer policy updates
• Meet established learning objectives and progress benchmarks
• Perform other miscellaneous duties as assigned by Practice Management
• Ensure compliance with all internal and external policies and regulations (including HIPAA)
• Acquiring a deep understanding and commitment to LUK’s Mission, Vision and Values, programming and advocacy

Requirements:

Knowledge and Experience Required

• Minimum 2–3 years of experience in mental health and/or medical billing and third-party accounts receivable
• Experience resolving claim rejections, pre-billing errors, and reimbursement discrepancies
• Familiarity with insurance and self-pay aging report management
• Working knowledge of MassHealth and MassHealth MCO billing requirements
• Experience with Medicare and Medicare MCO billing processes
• Familiarity with commercial payer requirements, policies, and procedures
• Experience obtaining prior authorizations from third-party payers
• Proficiency in insurance coverage verification
• Proficiency in electronic billing software for claims submission and client data management
• Working knowledge of Microsoft Office applications
• Ability to work collaboratively as part of a billing team
• Strong attention to detail and organizational skills
• Effective communication skills for client and payer interactions

Skills and Abilities

• Excellent customer service skills
• Ability to navigate and maintain electronic billing systems accurately
• Ability to handle information with the utmost confidentiality
• Ability to meet deadlines for timely claims submission and collections follow-up
• Skill in managing and prioritizing workload across multiple payer types simultaneously
• Capacity to maintain organized records and documentation in compliance with protocols
• Ability to effectively communicate with third-party payers, clients, and internal team members
• Skill in working collaboratively within a billing department team
• Capacity to professionally represent the organization in payer and client interactions
• Safe and reliable transportation
• Creative thinking and problem solving
• Ability to troubleshoot
• Strong internal motivation

How to Apply

Submit a cover letter and resume sharing your interest and unique qualifications for this position to:

Online: Click “Apply for Job” below, fill out demographic information, and attach your resume and cover letter.

Mail: Director of Human Resources

LUK, Inc.

545 Westminster Street

Fitchburg, MA 01420

Email: View email address on us.fitly.work with the subject line “Third Party Billing Specialist”

FAX: View phone number on us.fitly.work

Job Location

LUK’s Main Office in Fitchburg, MA.

Salary Range and Benefits

Pay Range: 12. Salary Range: $44,000 – $47,500. Salary ranges within each pay grade are based on qualifications, skills, and experience.

Contact LUK’s Human Resources Department for information on our exceptional Benefit Package.

For benefit-eligible positions, LUK provides an extensive and unique benefit package. For more information on LUK’s employment benefits please visit:

Position Overview

LUK Division: Administrative

LUK Component: Administration

Direct Supervisor: Billing Manager

LUK Staffing Category: _12_______

This position is __40 hours____ per week

This is a salary position: ?

This is an hourly position: ?

This position is benefit eligible: ?

This position is community-/home-based ?

EOE and Diversity Commitment

LUK is committed to fostering a welcoming and supportive workplace and is an Equal Opportunity Employer. Our team includes talented professionals from a wide range of backgrounds and experiences – from those with firsthand knowledge of the communities we serve to recent graduates and experienced professionals We believe that bringing together people with different perspectives makes us stronger and better equipped to serve our communities.