Insurance Billing & AR Specialist

The Stepping Stones Group, LLC; United States; On-site; USD 45,000 - 65,000; Full time

Job summary

The Stepping Stones Group, LLC is seeking an Insurance Team – Billing and AR Representative to join our dynamic AR department. You will focus on reducing denials, managing aging AR, and ensuring prompt submission of accurate claims for our client base.

The role requires familiarity with payer guidelines, experience with clearinghouses, and the ability to work with cross-functional teams to improve cash flow and reporting.

Qualifications

• Billing and AR experience in a medical or behavioral health setting.
• Familiar with payer guidelines and clearinghouses.
• Proficient in Microsoft Office.
• Strong attention to detail and data-driven, fast-paced.
• Ability to multitask and meet deadlines.
• Teamwork and customer service mindset.

Responsibilities

• Review and scrub billing records to ensure payer guidelines are met before submitting claims.
• Generate and submit claims; correct errors flagged by PMS and release to clearinghouse promptly.
• Correct rejected claims and identify trends to prevent repeats.
• Handle denials in the clearinghouse and communicate trends to relevant teams.
• Review total AR for assigned offices and ensure timely action on payers not processed via clearinghouse.
• Assist AR team with training and respond to AR questions.
• Collaborate with internal teams including clinical and non-clinical staff.
• Navigate payer portals and contact payers to obtain information on billing submissions or denials.
• Proactively identify AR trends and provide KPI support as needed.
• ABA-specific billing experience highly preferred; Experience with Central Reach and Waystar/Zirmed preferred.

Skills

Attention to detail

Data-driven

Teamwork

Customer service

Multitasking

Self-motivated

Tools

Waystar/Zirmed

Central Reach

Microsoft Office

Job description

Insurance Billing & Accounts Receivable Representative

What Does Success Look Like

At The Stepping Stones Group, we believe in transparency about the expectations of each team member. In joining our team as an Insurance Team – Billing and AR Representative, the following are the outcomes that our team and individual team members are working to achieve daily.

• Maintain zero denials in work queue for clearing house and identify trends to prevent subsequent denials
• Maintain and assist the team with 30 day or less approach for denials sitting in clearing house buckets
• Take proactive action on more than 90% of outstanding balances aged less than 90 days with no denial on record or unclear denial
• Assist in all AR questions and escalations from AR team
• Assist AR team with all training for new and current employees
• Partner with AR manager to ensure the team is following current collection layout
• Proactively identifying and communicating AR trends to the team
• KPI support as needed
• Support with larger payers with collection challenges (Ex, top 10 outstanding)
• Support with identifying zero payments in the clearinghouse

We believe that visibility and diligence ensure our team and team members maintain a sharp focus on achieving these outcomes. To best support each team members success in their roles, each team member participates in a daily team huddle where the measures are reviewed and support is provided.

Successful teammates at CAS live the following cultural competencies

• Fast paced and data driven. We treat speed as a competitive advantage. We use data, but we don’t get stuck in it. We make decisions and move on to the next obstacle.
• Persistence. We demonstrate tenacity and are willing to go the distance to finish the job.
• Follow-through on commitments. We live up to verbal and written agreements, always.
• Enthusiasm. We exhibit passion and excitement for our work. We maintain a “can-do” attitude.
• Flexibility/adaptability. We adapt quickly to changing priorities and conditions. We cope effectively with complexity and change.
• Teamwork & customer service. We like working together. We reach out to peers and cooperate with supervisors to establish collaborative working relationships. We do our work with a focus on customer service, recognizing that “customers” includes our clients and their families, and also supervisors, direct reports, colleagues and external partners.

Essential Job Functions

• Review and scrub billing records for insurance clients, ensuring that payer guidelines are met prior to generating a claim for submission
• Generate claims for claim submission, ensuring that claims are generated in adherence with payer guidelines
• Correct all claim errors that are flagged by the practice management system and release claims to the clearinghouse in a timely manner
• Review and correct all claims that reject by the clearinghouse or the payer, ensuring that feedback is looped back to prevent repeat rejections from occurring if there are trends identified
• Work all denials in the clearinghouse that are tied to your billing submissions, ensuring that trends are communicated to appropriate teams and denials aren’t aging out past 90 days
• Review total AR for assigned offices to ensure that payers who aren’t processed via the clearinghouse are being actioned on in a timely manner
• Other duties as assigned.
• Behavioral health claims billing and denial management experience. ABA-specific billing experience highly preferred
• Experience billing within a practice management system. Central Reach experience preferred
• Experience working within insurance payer guidelines
• Experience working within a clearinghouse. Waystar/Zirmed experience preferred
• Experience working in a fast paced, target-driven environment
• Experience aggregating data to report and communicate trends
• Experience calling out to payers to obtain information on billing submissions or denials
• Experience navigating payer portals
• Experience partnering internally, with both clinical and non-clinical teams
• Experience with Microsoft Office products
• Ability to multitask and maintain a strong work ethic
• Self-motivated, proactive, independent, and detail-oriented