Carolinacenterforaba12h ago

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Billing Specialist - Patient Accounts

United States·RaleighRemoteFull-Timemid

Finance & AccountingBilling Specialist

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Finance & AccountingBilling Specialist

Kind Behavioral Health is a leading provider of Applied Behavior Analysis services in North Carolina and Georgia, dedicated to improving the lives of children with autism spectrum disorder (“ASD”). We provide life-changing treatment to children with ASD, providing outstanding quality care, and delivering exceptional clinical outcomes, in an environment in which all are encouraged to THINK BIG, HAVE FUN, DO GOOD, and BE KIND. We deliver treatment through individualized care plans, and target socially significant behaviors, enabling the clients we serve to lead more independent, fulfilling lives. 

We are seeking a compassionate and detail-oriented Billing Specialist to join our team, focusing on patient responsibility collections while maintaining KBH's commitment to supporting families throughout their ABA journey. This role combines insurance patient responsibility collections expertise with strong family advocacy, helping connect families with resources to cover treatment costs while ensuring strong billing processes. The ideal candidate is empathetic, organized, and skilled at building positive relationships with families during sensitive financial conversations. The Billing Specialist will serve as a bridge between our billing operations and the families we serve, always prioritizing the continued care and support of our clients, while ensuring complete and timely collections performance.

1-3 years of experience in healthcare billing/collections, health insurance interactions, or patient financial services

Experience with insurance verification, claims processing, and accounts receivable

Knowledge of healthcare billing regulations and HIPAA compliance requirements

Strong customer service background with experience in sensitive financial conversations

Excellent communication skills, both written and verbal

Ability to resolve complex roadblocks independently and maintain diligent follow-up processes

Willingness to go above and beyond to connect families with resources and help them navigate payment for services

Familiarity with ABA Services preferred (CPT Codes 97151-97158) and Medicaid eligibility

Familiarity with EHR systems (CentralReach preferred), and Microsoft Office Suite (Excel, Word, Outlook)

Detail-oriented with strong organizational and time management skills

Ability to work independently and manage multiple priorities in a fast-paced environment

Familiarity working with both commercial insurance and government-funded (i.e., Medicaid and TRICARE) healthcare payors

Demonstrated experience driving payor accountability – comfortable pushing on payors and advocating for insurance coverage and timely claims payment on behalf of clients

Experience working with families or in pediatric, third-party reimbursed healthcare settings preferred

Patient Responsibility Collections

Manage patient responsibility accounts with kindness and professionalism

Develop and maintain flexible payment plans tailored to each family's unique financial circumstances, while ensuring ongoing adherence to agreed upon plans

Maintain detailed records of all collection activities, payment arrangements, and family communications

Monitor A/R aging reports to prioritize collection efforts

Process patient payments and apply them accurately to appropriate accounts and services

Family Resources & Support

Research and identify financial assistance programs, grants, and community resources offering financial support for families receiving autism services

Proactively connect families with autism-specific funding organizations and state assistance programs, and nonprofit resources

Maintain a comprehensive database of local and national resources for easy family referrals

Create educational tools and step-by-step guides for families to independently and easily access available financial assistance programs

Advocate for families during financial hardship by exploring all available support options

Benefits & Eligibility Checks

Primary point of contact, managing relationship with third-party automated insurance verification partner.

Manage our automated insurance verification process using our third-party benefits verification platform for all new intake clients and ongoing verification for existing clients

Review monthly eligibility checks to ensure continuous coverage and proactively identify policy changes

Determine and communicate to families applicable ABA coverage limits and exclusions, deductibles, copayments, and authorization requirements

Provide clear, understandable explanations to families about their insurance benefits, coverage details, and anticipated out-of-pocket costs based on verification results

Maintain accurate and up-to-date insurance information in patient records and promptly update any changes identified

When insurance changes occur, coordinate seamlessly across authorizations, scheduling, credentialing, and billing teams to ensure uninterrupted continuation of care

Identify potential coverage gaps through platform reporting and work with families to secure alternative funding sources before service interruption

Troubleshoot any platform issues and escalate complex verification cases to vendor support when needed

Claims Reprocessing & Appeals

Reprocess insurance claims when patient financial obligations have been incorrectly calculated or applied by insurance carriers

Prepare and file formal appeals for incorrectly denied claims, including compilation and submission of supporting clinical documentation

Track appeal outcomes and follow up on pending decisions within established timeframes

Maintain detailed logs of all reprocessing activities and communicate outcomes to relevant stakeholders

Payor Claims Enrollment (EFT & ERA enrollments)

Complete Electronic Funds Transfer (EFT) enrollment applications for new insurance payors

Set up Electronic Remittance Advice (ERA) enrollments to streamline payment processing and reconciliation

Maintain current enrollment status for all active insurance contracts and renew as needed

Proactively troubleshoot EFT and ERA processing issues and coordinate resolution with payor representatives

Update banking and contact information for electronic payment systems as organizational changes occur

KBH is committed to creating a diverse environment and we are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Diversity is more than a commitment at KBH- it is the foundation of what we do, adhering to the highest professional standards while creating an environment in which exceptional people (like you!) can think big, have fun, and do good.