Medical Biller

Professional Therapy Solutions; Buffalo Grove (IL); On-site; USD 65,000 - 90,000; Full time

Job summary

Professional Therapy Solutions is seeking an experienced healthcare billing professional in Buffalo Grove, IL to manage ABA authorizations, claims, and denials. The role collaborates with clinical, scheduling, and leadership teams to ensure timely reimbursements and accurate documentation.

Responsibilities include submitting authorization requests, following up with payers, auditing packets, tracking due dates with Monday.com, and resolving payment delays using Central Reach and other tools.

Qualifications

• 3–5 years of medical billing or revenue cycle experience.
• Experience with ABA billing and pediatric therapy preferred.
• Proficiency in Central Reach or similar practice management systems.
• Experience with insurance denials, appeals, and authorizations.
• Strong Microsoft 365 skills, including Excel, Outlook, Teams, and Word.

Responsibilities

• Submit ABA authorization requests and extension requests to insurance companies.
• Follow up with insurance case coordinators, including BCBS Illinois and other payors, regarding pending authorization requests.
• Audit clinical packets, supporting documentation, and assessments required for authorization approvals.
• Track authorization due dates and renewal timelines using Monday.com and other tracking systems.
• Support the development and submission of authorization appeals when services are denied or reduced.
• Review, scrub, and submit electronic and paper claims for ABA and therapy services.
• Research and resolve claim rejections, denials, and payment delays.
• Investigate payer-specific billing issues and implement corrective actions.
• Manage claim aging reports and follow up on outstanding accounts receivable balances for all disciplines.
• Write and submit claims appealing to recover denied reimbursement.
• Verify insurance eligibility, benefits, authorizations, and coverage requirements, primarily for ABA services.
• Document benefit information, authorization requirements, and payer communications in Central Reach.
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
• Post payments accurately and reconcile insurance payments.
• Identify denial trends and develop action plans for resolution.
• Complete Work-In-Progress (WIP) documentation by recording ERA dates, payment amounts, adjustments, and write-offs.
• Process and monitor secondary insurance billing for all disciplines.
• Track recoupments and overpayment requests received by mail and electronically, ensuring validity before repayment.
• Maintain detailed documentation of insurance calls, payer correspondence, and critical communications within Central Reach.
• Respond promptly to Teams messages, emails, and internal requests.
• Open and review insurance correspondence, identifying denials, requests for records, and reimbursement issues.
• Collaborate with clinical, scheduling, and leadership teams to resolve billing and authorization concerns.
• Monitor clean claim ratios and claim generation accuracy.
• Recommend process improvements to enhance reimbursement rates and operational efficiency.

Skills

ABA billing

Insurance authorization

Revenue cycle

Denials & appeals

Claims processing

Payer communication

Microsoft 365

Central Reach

Monday.com

Education

Healthcare administration / business degree

Tools

Central Reach

Monday.com

Insurance clearinghouses

Job description

Key Responsibilities

• Submit ABA authorization requests and extension requests to insurance companies.
• Follow up with insurance case coordinators, including BCBS Illinois and other payors, regarding pending authorization requests.
• Audit clinical packets, supporting documentation, and assessments required for authorization approvals.
• Track authorization due dates and renewal timelines using Monday.com and other tracking systems.
• Support the development and submission of authorization appeals when services are denied or reduced.
• Review, scrub, and submit electronic and paper claims for ABA and therapy services.
• Research and resolve claim rejections, denials, and payment delays.
• Investigate payer-specific billing issues and implement corrective actions.
• Manage claim aging reports and follow up on outstanding accounts receivable balances for all disciplines.
• Write and submit claims appealing to recover denied reimbursement.
• Verify insurance eligibility, benefits, authorizations, and coverage requirements, primarily for ABA services.
• Document benefit information, authorization requirements, and payer communications in Central Reach.
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
• Post payments accurately and reconcile insurance payments.
• Identify denial trends and develop action plans for resolution.
• Complete Work-In-Progress (WIP) documentation by recording ERA dates, payment amounts, adjustments, and write-offs.
• Process and monitor secondary insurance billing for all disciplines.
• Track recoupments and overpayment requests received by mail and electronically, ensuring validity before repayment.
• Maintain detailed documentation of insurance calls, payer correspondence, and critical communications within Central Reach.
• Respond promptly to Teams messages, emails, and internal requests.
• Open and review insurance correspondence, identifying denials, requests for records, and reimbursement issues.
• Collaborate with clinical, scheduling, and leadership teams to resolve billing and authorization concerns.
• Monitor clean claim ratios and claim generation accuracy.
• Recommend process improvements to enhance reimbursement rates and operational efficiency.

Education

• Associate's or bachelor’s degree in healthcare administration, Business, Accounting, or related field is required.

Experience

• Minimum 3 to 5 years of medical billing, insurance authorization, or revenue cycle experience.
• Prior experience with ABA billing and pediatric therapy services in behavioral health strongly preferred.
• Proven experience managing insurance denials, appeals, and authorizations.
• Proficiency with Central Reach or similar practice management systems.
• Experience with insurance clearinghouses and claims management platforms.
• Strong Microsoft 365 skills, including Excel, Outlook, Teams, and Word.
• Knowledge of Medicaid, Medicare, BCBS, and commercial insurance plans.
• Experience preparing authorization and claims appeals.
• Ability to communicate effectively via phone, email, and virtual platforms.
• Ability to manage detailed administrative work with a high level of accuracy.

Knowledge & Competencies

• Strong understanding of insurance billing processes, EOB interpretation, and revenue cycle management.
• Familiarity with payer requirements, authorization procedures, and pediatric therapy reimbursement guidelines.
• Excellent written and verbal communication skills.
• Strong organizational and time management abilities.
• Ability to manage multiple priorities while maintaining accuracy and compliance.
• Demonstrated problem-solving and analytical skills.