Claims Specialist; Substance Abuse Billing

Work Location: On-site - Fort Lauderdale, FL

Reports to: Claims Supervisor

Employment Status: Full-Time

FLSA Status: Non-Exempt

We are searching for a diligent Claims Follow-Up Specialist to ensure a timely and accurate collection of medical claims. The specialist will work closely with insurance companies to rectify payment denials, settle disputes, and receive due reimbursements. The ideal candidate will possess strong communication skills, a deep understanding of medical billing and coding, and the determination to resolve outstanding claims.

• Reviews and works on unpaid claims, identifying and rectifying billing issues.
• Communicates with insurance companies regarding any discrepancy in payments if necessary.
• Conducts research and appeals denied claims timely.
• Reviews Explanation of Benefits (EOBs) to determine denials or partial payment reasons.
• Provides detailed notes on actions taken and next steps for unpaid claims.
• Collaborates with the billing team to ensure accurate claim submission.
• Maintains a comprehensive understanding of the insurance follow-up process, payer guidelines, and compliance requirements.
• Resubmits claims with necessary corrections or supporting documentation when needed.
• Tracks and documents trends related to denials and work towards a resolution with the billing team.
• Assists patients with inquiries related to their insurance claims, providing clear and accurate information.
• All other duties as assigned.

• Proficiency in healthcare billing software.
• Strong analytical, organizational, and multitasking skills.
• Excellent verbal and written communication abilities.
• Ability to navigate payer websites and use online resources to resolve outstanding claims.

• High school diploma or equivalent required.
• Experience in medical billing collections or a similar role in a Behavioral Health industry specializing in Substance abuse and Mental Health is strongly preferred.
• Knowledge of medical terminology, CPT and ICD-10 coding is a plus.
• Knowledge of HIPAA and other healthcare industry regulations.

• Health Insurance
• Vision Insurance
• Dental Insurance
• 401(k) plan with matching contributions