Billing Specialist

Burlington Pediatrics/ Mebane Pediatrics; Burlington (NC); On-site; USD 42,000 - 60,000; Full time

Job summary

Burlington Pediatrics is seeking an experienced Billing Specialist – Medical & Integrated Care to join our billing team. This role focuses on medical insurance billing, payment posting, and insurance follow-up, with attention to Aetna, CHAMPVA, MedCost, and TRICARE.

The position also acts as an internal Integrated Care resource for mental/behavioral health eligibility, prior authorizations, and billing issues, requiring strong communication with providers and staff.

Qualifications

• Minimum 2 years of medical billing experience.
• Strong experience with insurance eligibility, benefits, claims, payment posting, and A/R.
• Experience with Aetna, CHAMPVA, MedCost, and TRICARE strongly preferred.
• Behavioral/mental health billing experience strongly preferred.
• Experience with NC Medicaid and commercial insurance.
• Experience with prior authorizations, denials, appeals, and corrected claims.
• Knowledge of CPT, HCPCS, ICD10, modifiers, and place of service codes.
• Strong attention to detail and organizational skills.
• Excellent problemsolving and criticalthinking abilities.
• Strong written and verbal communication skills.
• Ability to manage a high volume of claims and payments while maintaining accuracy.
• Pediatric billing experience, behavioral/mental health billing experience, and Office Practicum experience are a plus.

Responsibilities

• Manage medical claims for Aetna, CHAMPVA, MedCost, and TRICARE.
• Verify insurance eligibility, benefits, deductibles, copays, coinsurance, and coverage limitations.
• Research and resolve claim rejections, denials, and underpayments.
• Submit corrected claims, reconsiderations, and appeals.
• Monitor claims for timely filing and proper reimbursement.
• Follow up with insurance companies on outstanding claims and accounts receivable.
• Post insurance payments, contractual adjustments, denials, and patient responsibility accurately.
• Review EOBs, ERAs, and remittance information for accuracy.
• Identify incorrect payments, missing payments, and underpayments.
• Research discrepancies between payments received and expected reimbursement.
• Identify recurring payment or reimbursement issues and communicate trends to management.
• Obtain and track medical and behavioral health authorizations.
• Monitor authorization numbers, effective dates, approved services, and visit limits.
• Follow up on pending or denied authorization requests.
• Research authorization related claim denials and determine appropriate resolution.
• Serve as escalation resource for mental and behavioral health eligibility and benefits.
• Research payer-specific requirements for psychotherapy, telehealth, and integrated care services.
• Assist staff with complex behavioral health billing questions and billing issues.
• Communicate insurance requirements clearly to providers, clinical staff, frontoffice staff, and the billing team.

Skills

Insurance billing

Accounts receivable

Attention to detail

Communication skills

Team collaboration

Tools

CPT/HCPCS/ICD-10 knowledge

NC Medicaid experience

Office Practicum

Job description

Burlington Pediatrics is seeking an experienced and detail-oriented Billing Specialist – Medical & Integrated Care to join our billing team. This position will have primary responsibility for medical insurance billing, payment posting, and insurance follow-up, with a strong focus on Aetna, CHAMPVA, MedCost, and TRICARE. The Billing Specialist will also serve as an internal Integrated Care resource for mental and behavioral health eligibility and benefits escalation, and prior authorization requirements.

Key Responsibilities

Medical Insurance Billing & Follow-Up

• Manage medical claims for Aetna, CHAMPVA, MedCost, and TRICARE.
• Verify insurance eligibility, benefits, deductibles, copays, coinsurance, and coverage limitations.
• Research and resolve claim rejections, denials, and underpayments.
• Submit corrected claims, reconsiderations, and appeals.
• Monitor claims for timely filing and proper reimbursement.
• Follow up with insurance companies on outstanding claims and accounts receivable.

Insurance Payment Posting

• Post insurance payments, contractual adjustments, denials, and patient responsibility accurately.
• Review EOBs, ERAs, and remittance information for accuracy.
• Identify incorrect payments, missing payments, and underpayments.
• Research discrepancies between payments received and expected reimbursement.
• Ensure payments and adjustments are posted to the appropriate patient accounts and dates of service.
• Identify recurring payment or reimbursement issues and communicate trends to management.

Integrated Care – Mental & Behavioral Health Resource

• Serve as the escalation resource for mental and behavioral health eligibility and benefits questions.
• Research behavioral health coverage, copays, deductibles, coinsurance, visit limits, and exclusions.
• Determine whether mental and behavioral health services require prior authorization or referrals.
• Obtain and track behavioral health prior authorizations.
• Research payerspecific requirements for psychotherapy, nutritional, behavioral health, integrated care, and telehealth services.
• Assist staff with complex behavioral health insurance questions and billing issues.
• Communicate insurance requirements clearly to providers, clinical staff, frontoffice staff, and the billing team.

Prior Authorizations

• Obtain and track medical and behavioral health authorizations.
• Monitor authorization numbers, effective dates, approved services, and visit limits.
• Follow up on pending or denied authorization requests.
• Research authorization related claim denials and determine appropriate resolution.

Qualifications

• Minimum 2 years of medical billing experience.
• Strong experience with insurance eligibility, benefits, claims, payment posting, and A/R.
• Experience with Aetna, CHAMPVA, MedCost, and TRICARE strongly preferred.
• Behavioral/mental health billing experience strongly preferred.
• Experience with NC Medicaid and commercial insurance.
• Experience with prior authorizations, denials, appeals, and corrected claims.
• Knowledge of CPT, HCPCS, ICD10, modifiers, and place of service codes.
• Strong attention to detail and organizational skills.
• Excellent problemsolving and criticalthinking abilities.
• Strong written and verbal communication skills.
• Ability to manage a high volume of claims and payments while maintaining accuracy.

Pediatric billing experience, behavioral/mental health billing experience, and Office Practicum experience are a plus.