Billing Specialist

• Verify coverage: Confirm insurance eligibility, benefits, and payer-specific requirements for all new admissions and existing clients
• Update systems: Maintain precise insurance records within the EHR and communicate coverage limitations or authorization needs to staff
• Secure approvals: Obtain, track, and maintain authorizations for behavioral health and substance use disorder (SUD) services
• Coordinate tracking: Manage expiration dates, submit Notices of Admission (NOAs), and collaborate with utilization review to prevent gaps in coverage
• Audit accounts: Review documentation and authorizations prior to claim submission to prevent payment delays
• Partner with contractors: Coordinate directly with the agency's external billing contractor to resolve edits, corrections, and claim issues
• Stay compliant: Ensure all billing aligns with MassHealth, Medicare, Medicaid MCOs, commercial guidelines, BSAS, and HIPAA regulations
• Act as an expert: Research payer updates and serve as the internal resource for evolving billing policies
• Analyze trends: Identify systemic billing errors or authorization issues contributing to claim denials
• Improve processes: Partner across admissions, clinical, and finance teams to implement process improvements that protect revenue
• Lead the team: Act as a mentor to Billing Specialists, assist with onboarding, and develop workflow documentation
• Support leadership by assisting the Billing Manager with audits, special projects, and departmental reporting

• Associate degree in Healthcare Administration, Business Administration, Accounting, Finance, or related field preferred
• Equivalent work experience may be substituted for formal education
• Minimum of five (5) years of healthcare billing experience
• Minimum of three (3) years of experience in insurance verification, authorizations, billing support, claims preparation, or payer relations
• Experience in Behavioral Health and/or Substance Use Disorder services strongly preferred
• Experience working with MassHealth, Medicare, Medicaid Managed Care Organizations, and commercial insurance plans
• Must be able to successfully pass a CORI/Background records check
• Compliance with Veterans Inc. COVID-19 Vaccination Policy

Experience in Behavioral Health and/or Substance Use Disorder services strongly preferred

• BCBS Medical, Dental, and Vision Insurance
• Employer Paid Short and Long-Term Disability and Life Insurance
• $2500 Medical Opt-Out program if you have medical coverage through another source
• Retirement Plan (403B) with a $2000 Match
• Flexible Spending Accounts
• Tuition Reimbursement Program
• Paid Parental Leave