Claims Resolution Specialist

Claims Resolution Specialist – Behavioral Health – Exact Billing Solutions (EBS), Lauderdale Lakes, FL Pay Range

Base pay: $58,240.00/yr – $64,480.00/yr (exact amount will be based on skill and experience).

Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in substance use disorder, mental health, and autism care. With proprietary billing processes, deep industry knowledge, and a reputation for innovation, EBS helps partner healthcare companies streamline operations and accelerate cash flow. Company values: integrity, dependability, and attention to detail.

As a Claims Resolution Specialist – Behavioral Health, you will coordinate with insurance companies and clients to secure maximum benefits. The role supports multiple expanding clinic locations; timely collections are critical to our operations and directly impact client families and children.

• Review and manage assigned accounts receivable inventory to ensure timely follow‑up on outstanding claims.
• Investigate and resolve denials, rejections, and underpayments by working directly with payors and internal teams.
• Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.
• Document all collection activities clearly and accurately within our systems.
• Monitor payor trends and elevate recurring issues to leadership.
• Meet or exceed daily, weekly, and monthly productivity and quality standards.
• Support special projects and process improvement initiatives as assigned.
• Maintain effective communication with third‑party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction.
• Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc.
• Enter status claims and add notes in the patient accounting system (Collaborate
  
  MD).
• Escalate any payor or client claim issues to department leadership.
• Establish/maintain effective communications with the leadership team to ensure compliance with third‑party guidelines.
• Update patient demographics and insurance information as needed.
• Maintain productivity KPI metrics.

• Review and manage assigned AR inventory to ensure timely follow‑up on outstanding claims.
• Investigate and resolve denials, rejections, and underpayments by working directly with payors, and internal teams.
• Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.
• Document all collection activities clearly and accurately within our systems.
• Monitor payor trends and elevate recurring issues to leadership.
• Meet or exceed daily, weekly, and monthly productivity and quality standards.
• Support special projects and process improvement initiatives as assigned.
• Maintain effective communication with third‑party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction.
• Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc.
• Enter status claims and add notes in the patient accounting system (Collaborate
  
  MD).
• Escalate any payor or client claim issues to department leadership.
• Establish/maintain effective communications with the leadership team to ensure compliance with third‑party guidelines.
• Update patient demographics and insurance information as needed.
• Maintain KPI metrics for productivity.

• Associate’s degree (preferred).
• At least 3 years of behavioral health out‑of‑network billing experience.
• Experience with Collaborate
  
  MD EMR and billing software.
• Experience with ABA therapy (preferred).
• Knowledge of CPT and ICD‑10 codes (preferred).
• Claims denial experience with follow‑up from payers including appeals.

• 21 paid days off (15 days PTO, increasing with tenure, plus 6 holidays).
• Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
• Medical, dental, vision, long‑term disability, and life insurance.
• Generous 401(k) with up to 6% employer match.

Integrity, dependability, and attention to detail are the cornerstones of our team. We are a fast‑paced, growing company dedicated to enabling clients to spend more time helping people. Exact Billing Solutions participates in the U.S. Department of Homeland Security E‑Verify program.

• Seniority Level: Associate
• Employment Type:
  
  Full‑time
• Job Function:
  Other
• Industries: IT Services and IT Consulting