Medical Billing Specialist

Associates for Human Services, Inc.(AHS) is seeking a detail-oriented and experienced Medical Billing Specialist to support the billing and reimbursement functions of our Early Intervention Program. This position plays an important role in ensuring that services provided to children and families are accurately billed, claims are processed timely, and reimbursement is received from public and private payers.

The ideal candidate will have experience with medical or healthcare billing, strong attention to detail, and the ability to research and resolve billing issues independently. Experience with Massachusetts Early Intervention billing, Mass Health, and commercial insurance is highly preferred.

• Prepare, review, and submit accurate and timely claims for Early Intervention services to Mass Health, commercial insurance carriers, and other applicable payers.
• Review service documentation and billing information to ensure services are accurately captured and billed.
• Verify insurance eligibility and coverage and maintain accurate payer information.
• Obtain, track, and monitor insurance authorizations when required.
• Monitor submitted claims and follow up on unpaid, rejected, or denied claims.
• Research claim denials and billing discrepancies and complete necessary corrections, resubmissions, or appeals.
• Review Explanation of Benefits (EOBs), Electronic Remittance Advices (ERAs), and payer correspondence to identify payment and denial issues.
• Post and reconcile insurance payments and adjustments as appropriate.
• Monitor outstanding accounts receivable and proactively follow up on aging claims.
• Identify recurring billing or denial trends and work with program and administrative staff to resolve underlying issues.
• Maintain accurate billing records and supporting documentation in accordance with payer requirements and agency procedures.
• Work collaboratively with Early Intervention program staff to resolve documentation, authorization, demographic, insurance, and billing issues.
• Assist with billing reconciliations and reports to ensure that services provided are appropriately billed and reimbursed.
• Maintain knowledge of applicable Early Intervention payer requirements and changes in Mass Health and commercial insurance billing practices.
• Protect confidential client and health information and comply with HIPAA and agency confidentiality requirements.
• Assist with audits, payer inquiries, and requests for billing documentation as needed.
• Perform other billing and administrative responsibilities as assigned.

• High school diploma or equivalent required; associate degree in healthcare administration, medical billing, accounting, business, or a related field preferred.
• Minimum of 2 years of medical billing, healthcare billing, or accounts receivable experience preferred.
• Experience with Massachusetts Early Intervention billing strongly preferred.
• Experience billing Mass Health and commercial insurance carriers highly desirable.
• Knowledge of insurance eligibility, authorizations, claim submission, payment posting, denials, appeals, and accounts receivable follow-up.
• Understanding of medical billing terminology, payer requirements, and HIPAA regulations.
• Strong analytical and problem-solving skills with the ability to research and resolve billing discrepancies.
• Excellent attention to detail and accuracy.
• Strong organizational and time-management skills with the ability to manage multiple priorities and meet billing deadlines.
• Ability to communicate professionally with insurance carriers, program staff, families, and other internal and external contacts.
• Proficiency with Microsoft Office, particularly Excel, and the ability to learn electronic health record and billing systems.
• Ability to work both…