Billing and Claims Specialist

Socket.dev; Westbrook (CT); Hybrid; USD 33,000 - 36,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

401(k) with employer match

Paid time off

Wellness benefits

Employee assistance program

Job summary

Lumibility is seeking a Billing & Claims Specialist to support the Children & Family Services division. The role emphasizes accurate state database billing, data entry, and prompt payment processing in a hybrid Connecticut environment.

Responsibilities include correcting billing records, running reconciliation reports, and collaborating with the billing company to resolve denials and reimbursements. Prior experience in medical billing with ICD/10 and CPT coding is essential.

Qualifications

• High school diploma/GED required
• Bachelor’s degree in related field preferred
• Proficiency in Microsoft Office software including Word, Outlook, and Excel
• Must possess a valid Connecticut driver’s license, driving history acceptable and own vehicle for Lumibility business
• Bilingual (Spanish) preferred
• Experience with medical billing, insurance reimbursement and reconciliation, preferably in a clinical/medical environment
• ICD/10 and CPT coding experience required
• Knowledge of insurance/Medicaid practices required
• Ability to recognize discrepancies in billing data and investigate resolution
• Excellent interpersonal skills and phone interactions
• Strong organizational skills and ability to work in a fast-paced environment
• Must have internet access, cell phone, private workspace, and reliable transportation

Responsibilities

• Input employee and independent contractor billing information into state database accurately and expeditiously
• Initiate internal billing corrections and voids process according to procedure and make corrections
• Run reconciliation reports to identify data and billing errors, adjudication reports and corrections
• Enter client data from eligibility documents including insurance forms and statements of eligibility into state database
• Review and identify errors proactively and take necessary action to resolve
• Work collaboratively with billing company, opening tickets, investigating and working claims, adjudication, denials, appeals and reimbursement
• Update knowledge by training opportunities and current on procedures; adhere to standards
• Maintain communication with other departments to promote positive relationships
• Develop processes addressing systems and create checklists for checks and balances
• Verify insurance information in state and private databases
• Enter insurance information in state database
• Participate in Community of Practice meetings and subcommittees
• Perform other roles within the office team as requested
• Provide interpretation for families during phone conversations if bilingual

Skills

Communication

Interpersonal skills

Data entry

Organizational skills

Problem solving

Team collaboration

Ability to travel

Attention to detail

Adaptability

Education

Bachelor's degree

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Job description

Description

OBJECTIVE:

Assist in the overall daily office and administrative activities to support the Children & Family Services division of Lumibility.

QUALIFICATIONS:

• High school diploma/GED required
• Bachelor’s degree in related field preferred
• Proficiency in Microsoft Office software including Word, Outlook, and Excel
• Must possess a valid Connecticut driver’s license, have an acceptable driving history and be able to utilize your own vehicle for Lumibility business as defined by Lumibility’s policy
• Bilingual (Spanish) preferred
• Experience with medical billing, insurance reimbursement and reconciliation, preferably in a clinical/medical environment required
• ICD/10 and CPT coding experience required
• Knowledge of insurance/Medicaid practices required
• Ability to recognize discrepancies in billing data and investigate the issue to determine resolution
• Excellent interpersonal skills and phone interactions
• Must have strong organizational skills and the ability to work in a fast-paced environment
• Must have internet access, a cell phone, private workspace, and reliable transportation

Hours: 40 hours/week, M-F, Non-Exempt

Location: Hybrid

Pay Rate: $24 - $26 per hour

ESSENTIAL JOB FUNCTIONS:

• Input employee and independent contractor billing information into state database accurately and expeditiously to ensure proper records handling and prompt payment responses
• Initiate internal billing corrections and voids process according to procedure and make corrections in agency and state database
• Run reconciliation reports to identify data and billing errors, adjudication reports and follow up to make corrections
• Enter client data from eligibility documents including insurance forms and statements of eligibility into state database
• Review and identify errors proactively and take necessary action to track and resolve
• Work collaboratively with the state contacted billing company, opening tickets, investigating and working claims, adjudication, denials, appeals and reimbursement
• Update job knowledge by participating in training opportunities and keeping current on state contract, insurance billing and reimbursement procedures. Adhere to company standards and federal and state requirements
• Maintains communication with other departments to promote positive working relationships and open communication
• Develop processes to address systems (embed resources and procedure changes into office procedures, create a day-to-day task priority list, determine needed changes to current procedures, create checklists for checks and balances and revise as needed)
• Verify insurance information in state and private insurance company database
• Enter insurance information in state database
• Participate in state led Community of Practice meetings and subcommittees, work collaboratively with Business Operations Manager to generate and maintain procedures related to the Billing & Claims position
• Perform other roles within the office team to provide support as requested
• Contribute during meetings and training sessions
• Performs other duties as assigned.
• If bilingual, provides interpretation for families during phone conversations and verifies translated documents as needed.

Requirements

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of medical billing and insurance reimbursement
• Knowledge of medical coding preferred
• Knowledge of company policies and procedures and applicable regulatory requirements and standards
• Skill in data entry, analyzing information, documentation and reporting
• Skill in planning, organizing, attention to detail and work in a fast-paced environment
• Skill in problem solving and decision making
• Skill in operating standard office equipment, computer and various software packages
• Skill in communicating effectively in a courteous and professional manner
• Skill in writing clearly and concisely to maintain accurate records
• Ability to read and understand policies and regulations and to translate general guidelines into specific action
• Possess critical thinking skills
• Ability to demonstrate good communication and interpersonal skills necessary to provide guidance and instruction to families
• Ability to work successfully, both independently and in a team environment
• Ability to maintain confidentiality
• Ability to maintain a patient and positive attitude
• Ability to drive/travel to varying locations as needed
• Ability to identify and prioritize daily tasks depending on timelines related to daily workflow
• Skill in planning, implementation, self-monitoring and organization
• Skill in effective problem-solving and decision making
• Ability to stay current with changing technology trends
• Ability to work flexible hours and travel as needed

Benefits include medical, dental, and vision coverage; life and disability insurance, a 401(k) with employer match, paid time off, wellness benefits and employee assistance programs. We are committed to supporting family-centered practices and providing opportunities for professional growth.

Lumibility is an Equal Opportunity Employer