Billing Specialist

Job Title:

Billing Specialist

Reports to:

Executive Director

Job Classification:
Non-Exempt

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Position Summary:

The Billing Specialist is responsible for timely and accurate billing, accounts receivable, and credentialing activities that support St. Monica's revenue cycle and payer participation. This role supports organizational revenue through claim submission, payment follow-up, resolution of billing issues, accurate documentation, and coordination with payers and internal teams.

Core Responsibilities:

• Manage billing and accounts receivable activities for Region 5, Medicaid, private insurance, and other applicable funding sources.
• Ensure claims and invoices are submitted accurately, completely, and within required time frames.
• Monitor outstanding accounts receivable and follow up on unpaid, underpaid, rejected, or denied claims to support timely resolution and payment.
• Research billing discrepancies and denials; make necessary corrections and resubmit claims or provide additional information as required.
• Maintain accurate billing, payment, and accounts receivable records and documentation.
• Identify recurring billing or reimbursement issues and communicate concerns, trends, or needed process improvements to leadership.
• Manages organizational and provider credentialing, recredentialing, enrollment, and contracting processes with Medicaid, managed care organizations, commercial insurance plans, and other applicable payers.
• Maintains credentialing and enrollment requirements and coordinates with providers, payers, and internal leadership to support continuous and accurate payer participation.
• Meets Job Expectations for Billing Specialist.
• Performs other duties as assigned.

Core Competencies (All Positions):

• Communication:
  Communicates clearly, respectfully, and professionally.
• Professionalism & Ethics:
  Demonstrates integrity, accountability, and appropriate boundaries.
• Confidentiality & Compliance:
  Adheres to HIPAA, 42 CFR, and organizational policies.
• Cultural Responsiveness:
  Practices respect, inclusion, and cultural humility.
• Reliability & Accountability:
  Maintains dependable attendance and completes work accurately and on time.
• Teamwork:
  Works collaboratively to support organizational goals.

Position-Specific

Competencies:

• Billing & Revenue Cycle:
  Accurately submits claims and supports billing through payment or appropriate resolution.
• Accounts Receivable Follow-Up:
  Proactively monitors outstanding balances and pursues timely reimbursement.
• Problem Solving & Attention to Detail:
  Researches discrepancies and denials and completes accurate corrections and follow-up.
• Administrative Organization:
  Maintains accurate billing records, documentation, and follow-up across systems.
• Payer & Stakeholder Communication:
  Communicates professionally and persistently with payers and internal partners to resolve billing issues.
• Credentialing & Payer Enrollment:
  Coordinates provider and organizational credentialing, enrollment, and recredentialing processes accurately and within required timelines.

Education and Experience:

• High School diploma or equivalent required;
  Business degree preferred.
• Previous medical billing experience required; behavioral health or substance use treatment billing experience preferred.
• Experience with electronic billing and electronic claim submission required.
• Experience with Medicaid, private insurance, accounts receivable follow-up, and denied claims preferred.
• Must be at least 21 years of age.
• First Aid/CPR certification required or ability to obtain certification (training provided).
• Valid driver’s license and insurance required upon hire.

Physical Requirements:

• Ability to perform the essential functions of the position, with or without reasonable accommodation. This may include lifting up to 25 lbs, climbing stairs, prolonged computer use, and working in a fast-paced, deadline-oriented environment.

Additional Information:

This job description reflects the general responsibilities and competencies required for the position and is not intended to be an exhaustive list of duties. Responsibilities may evolve to meet organizational needs.

St. Monica’s Home is an equal opportunity employer. We do not discriminate against any employee or applicant for employment based on age, race, religion, color, ethnicity, disability, gender, sexual orientation, gender identity, or national origin.