Accounts Receivable Denial Specialist

Behavioral Health Network, Inc.; Springfield (MA); Remote; USD 32,000 - 37,000; Full time

Benefits offered by this job

PTO

403(b)

Educational assistance

Medical insurance

Dental insurance

Vision insurance

Employee assistance program

Job summary

Behavioral Health Network, Inc. is seeking an experienced Medical Billing Specialist to support Western Massachusetts-based claims processing and follow-up. The role emphasizes AR management, appeals, and accurate coding within Behavioral Health guidelines.

You will review denials, file appeals, and work with payer systems to ensure timely reimbursements. This is a remote position requiring 8am-4pm Eastern exposure, with comprehensive benefits and professional growth opportunities in a

Qualifications

• Minimum of 5 years in a medical billing department with strong AR account follow-up, appeals, and Behavioral Health codes and modifier knowledge.
• Demonstrated knowledge of and experience in healthcare medical billing, claims processing, follow-up, and appeals.
• Carelogic EHR experience is preferred but not required.

Responsibilities

• Follows up on all assigned claims (at 45 days, 60 days, and 90 days) to ensure timely reimbursement and bring claims to closure.
• Reviews denied claims for accuracy to ensure coding, billing rates, and modifiers are accurate before sending appeals or reconsiderations to payers.
• Investigates claims with no payer response to ensure the payer received the claim.
• Navigates payer websites and appeal processes as defined by all payers including Mass Health, Tricare, Medicare, Medicaid, and Medicare Advantage plans.
• Reviews and finds trends or patterns of denials to prevent errors.
• Assists and confers with the EHR Matrix team and Billing Manager concerning any coding or modifier setup issues.
• Responsible for identifying missing payments, overpayments, and analyzing credits on accounts.
• Initiates refund requests for credit and overpayments.

Skills

AR follow-up

Medical billing

Claims processing

Appeals

HIPAA compliance

Education

High School Diploma or GED

Tools

Carelogic EHR

Job description

What We Offer:

• Purpose-Driven Work - Make a meaningful impact in the lives of individuals, families, and communities throughout Western Massachusetts.
• Professional Growth - Access ongoing training, mentorship, career development, and advancement opportunities across one of the region's largest behavioral health organizations.
• Supportive Team Culture - Join a collaborative workplace guided by our HEART values: Humanity, Empowerment, Accountability, Respect, and Teamwork.
• Stability & Opportunity - Build your career with a well-established organization serving Western Massachusetts since 1938.
• Comprehensive Benefits - Generous PTO, 403(b), educational assistance, medical, dental, vision, employee assistance programs, and more.
• Certified Great Place to Work - Work for an organization recognized for creating a positive and engaging employee experience.

What You Will Do:

• Follows up on all assigned claims (at 45 days, 60 days, and 90 days) to ensure timely reimbursement and bring claims to closure.
• Reviews denied claims for accuracy to ensure coding, billing rates, and modifiers are accurate before sending appeals or reconsiderations to payers.
• Investigates claims with no payer response to ensure the payer received the claim.
• Navigates payer websites and appeal processes as defined by all payers including commercial and government payers including Mass Health, Tricare, Medicare, Medicaid, and Medicare Advantage plans.
• Reviews and finds trends or patterns of denials to prevent errors.
• Assists and confers with the EHR Matrix team and Billing Manager concerning any coding or modifier setup issues.
• Responsible for identifying missing payments, overpayments, and analyzing credits on accounts.
• Initiates refund requests for credit and overpayments.

Who You Are:

• High School Diploma or GED required.
• Minimum of 5 years of experience in a medical billing department with strong AR account follow-up, appeals, and Behavioral Health codes and modifier knowledge required.
• Demonstrated knowledge of and experience in healthcare medical billing, claims processing, follow-up, and appeals required.
• Carelogic EHR with working knowledge and experience is a strong preference but not required.
• Must be a critical thinker with strong research, analytical, and mathematical skills required.
• Current knowledge of HIPAA compliance, 42 CFR requirements, and changing regulatory guidelines.
• Extensive comprehension in utilizing email, search engines, and the Internet with the ability to effectively use payer websites.

PAY: $23 - $27/hour (depending upon experience)

This is a REMOTE position - must be able to work 8am-4pm Eastern

Since 1938, BHN has delivered high-quality, culturally responsive behavioral health care, building deep roots in Western Massachusetts while expanding our impact in communities throughout the state.

Our core values-Humanity, Empowerment, Accountability, Respect, and Teamwork-guide how we lead, serve, and support one another.

If you're ready to bring your skills and experience to a mission-driven organization where your work can make a meaningful difference, we'd love to hear from you.

BHN is committed to social justice and diversity and strongly encourages diverse candidates to apply. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.