Billing & Eligibility Specialist

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DEPARTMENT:                  Accounting & Finance Department

JOB TITTLE:                       Billing & Eligibility Specialist

JOB SUMMARY:   The Billing & Eligibility Specialist bills insurance companies for all billable procedures; pursues collection of all claims until payment is made by insurance companies; and performs other work associated with the billing process (e.g. payment posting).  The individual performs critical billing functions including but not limited to eligibility verification and denial management to maximize revenue collections.  They also coordinate critical billing functions with the front office staff in each clinic.  The Billing & Eligibility Specialist also performs billing functions for non-clinic based Medicaid services (e.g. Health Homes).  This individual is responsible working with supervisor of the accounts receivable department to review problem accounts and identify necessary action to be taken.   The individual will report to Revenue Cycle Manager.


  • Prepares and submits clean claims to various insurance carriers on a daily basis.
  • Verifies client insurance coverage through our eligibility portal on a daily basis.
  • Obtains, tracks, and updates authorizations per insurance carriers.
  • Acts as liaison between clients and restricted facility.
  • Analyzes and resolves outstanding receivables utilizing remittance reports and/or explanation of benefits (EOBs), etc.
  • Performs accurate and timely follow-up, reconciliation and resolution of outstanding account balances.
  • Updates client billing information in eCR (electronic clinical record) as often as needed.
  • Refers accounts for billing where appropriate, reassign eligible balances to self-pay and/or Medicaid, Medicare, and Third party billing status.
  • Performs all denial management functions.
  • Works with clinical staff to ensure that correct diagnosis/procedures are reported to Medicaid, Medicare, and third-party insurance carriers.
  • Keeps updated on all billing and benefit changes for Medicaid, Medicare, and third-party insurance carriers.
  • Posts Medicaid, Medicare, and third-party insurance remittance claims in eCR.
  • Monitors claims for missing information and authorization numbers.

Please send all inquiries and your resume and cover letter to Erin Trim, Senior Financial Manager: