Full Time Billing & Claims Specialist

Behavioral Health Clinic

Job Location:

Wausau, WI - USA

Hourly Salary: $ 24 - 28

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Job Title: Full Time Billing and Claims Specialist

Reports to: Director of Operations

Description: The Billing and Claims Specialist plays a key role in supporting the financial operations of Behavioral Health Clinic (BHC) by managing the full lifecycle of insurance claims and patient accounts. This position is responsible for submitting and processing claims resolving denials maintaining accurate accounts receivable and supporting patient financial communications.

This role also serves as a resource for patients by providing clear compassionate guidance regarding billing insurance coverage and financial responsibility. The Billing and Claims Specialist works collaboratively with clinicians front office staff and insurance companies to ensure accurate billing practices timely reimbursement and a positive patient financial experience.

Duties and Responsibilities:

Claims & Billing Operations

Submit insurance claims using the Electronic Health Record (EHR) and claims processing systems
Oversee accurate coding of services using ICD-10 and DSM-5 guidelines
Enter and reconcile payments (ERA EFT and manual payments)
Run billing cycle reports and monitor claim status
Research payer policies coding rules and reimbursement guidelines to ensure compliance
Prepare and distribute billing statements

Denials Management & Issue Resolution

Review research and resolve denied and rejected claims
Work directly with insurance companies to correct and resubmit claims
Identify trends in denials and collaborate with internal teams to prevent future issues
Coordinate with front office and clinical staff to resolve documentation or insurance discrepancies

Accounts Receivable & Patient Financial Management

Review patient accounts regularly to identify outstanding balances and initiate follow-up
Ensure accurate setup of patient financial accounts including correct insurance sequencing (primary/secondary)
Contact patients regarding balances insurance issues or payment options via phone email and mail
Establish and monitor payment plans including follow-up on missed payments
Assist patients in understanding billing statements EOBs and financial responsibility with clarity and empathy
Manage patient collections processes including preparation of accounts for third-party collections in alignment with clinic policies
Serve as a point of contact for collection agency coordination

Compliance & Documentation

Maintain accurate and timely documentation of all account activity within the EHR and billing systems
Ensure compliance with HIPAA financial privacy laws and ethical billing practices

Additional Responsibilities

Collaborate with internal teams to improve billing workflows and reduce errors
Support patient experience through professional solution-focused communication
Other duties as assigned

Qualifications:

High school diploma or equivalent required; associates degree in healthcare administration business or related field preferred
25 years of experience in healthcare billing claims processing or patient accounts preferred
Knowledge of medical billing coding insurance processes and accounts receivable workflows
Experience with EHR and billing systems
Strong attention to detail organization and time management skills
Excellent written and verbal communication skills including patient-facing communication
Ability to work independently and collaboratively
Proficiency in Microsoft Office and Google Workspace
Willingness to learn adapt and work occasional overtime

Benefits:

Starting pay range: $24.00 $28.00 per hour (based on experience)
Healthcare Benefit Package including Dental Vision STD LTD and Retirement Plan options
Supportive and collaborative team environment with opportunities for advancement
Paid Time Off (PTO) and Holidays

*In accordance with legal requirements and company policies successful candidates for this position will be required to complete the form I-9 Employment Eligibility Verification as part of the BHC Onboarding Process*

Required Experience:

Job Title: Full Time Billing and Claims SpecialistReports to: Director of OperationsDescription: The Billing and Claims Specialist plays a key role in supporting the financial operations of Behavioral Health Clinic (BHC) by managing the full lifecycle of insurance claims and patient accounts. Thi...