Third Party Billing & Collections Specialist I

Bay Cove Human Services, Inc.; Boston (MA); On-site; USD 28,000 - 39,000; Full time

Job summary

Bay Cove Human Services is hiring a Billing Specialist to administer third‑party billing for diverse programs serving children and adults in Greater Boston and southeastern Massachusetts. The role supports accurate claims, timely submissions, and effective denial management.

You will monitor payer rules, submit claims electronically, correct denials, run AR reports, and follow up with insurers to improve payment outcomes while protecting client confidentiality under HIPAA regulations.

Qualifications

• Minimum of two years of third party billing experience in mental health, substance use, or related fields.
• Experience with MS Excel and ability to learn new software quickly.
• Strong organizational skills and ability to meet deadlines in a fast-paced environment.
• Ability to work collaboratively with diverse staff and payers.
• Professional documentation and communication skills.

Responsibilities

• Monitor payer rules and communicate changes to Billing Manager.
• Electronic submission of claims to clearinghouses for assigned payers.
• Correct payer rejections and run AR and denial management reports.
• Follow up with insurers on status and collectability of unpaid/denied claims.
• Post denials to AR Plus and rebill/appeal per payer policies.
• Participate in special projects and maintain HIPAA confidentiality.
• Respond to staff and client questions and meet all project timeframes.

Skills

Third party billing experience

MS Excel

Organizational skills

Communication skills

Team collaboration

Deadline-driven

HIPAA compliance awareness

Tools

MS Excel

Job description

Bay Cove Human Services’ mission is to partner with people to overcome challenges and realize personal potential. Bay Cove pursues this mission by providing individualized and compassionate services to people facing the challenges associated with developmental disabilities, mental illness, substance use disorders, and homelessness at more than 175 program sites throughout Greater Boston and southeastern Massachusetts.

Job Summary

Our mission is to provide high-quality services to children and adults who face the life-long challenges of mental illness, drug and alcohol dependency, aging, and developmental disabilities. Your position as Billing Specialist supports this mission by the administration of third party billing.

Responsibilities

• Monitor changes in payers’ rules and procedures, by reviewing assigned payer websites, and communicate information to Billing Manager.
• Electronic submission of claims to clearinghouse(s) for assigned payers/programs
• Correction of assigned payer rejected claims in clearinghouse
• Run A/R Plus problem and hold report and correct any issues
• Run AR report for assigned payers/programs, working report based on Best Practices
• Make follow-up calls to insurers regarding the status and collectability of unpaid or denied claims.
• Post denials to AR Plus as needed.
• Complete rebilling/appeals of denied claims, pursuant to payer policies and regulations.
• Participate in special projects for appeals, rebilling, and corrective billing as necessary and within all designated timeframes for each project.
• Respond to staff and client questions as needed
• Maintain the confidentiality of client information according to HIPAA regulations.
• Comply with all department and agency policies and procedures.
• Follow up with the manager regarding any other issues or problems discovered as part of the above activities.

Qualifications

• Minimum of two years of relevant third party billing experience (ie, mental health, substance abuse, developmental disabilities, senior services)
• Experience in MS Excel and computer literacy; ability to learn new software quickly
• Highly developed organizational skills and ability to meet deadlines in a fast-paced work environment
• Demonstrated ability to work effectively and collaboratively with a diverse population of colleagues, program staff, and payers
• Demonstrated ability to work both independently and within a team
• Professional documentation and communication skills
• Ability to be flexible, open, and responsive to ongoing industry changes
• Ability to identify opportunities and obstacles and develop effective, creative responses to both problem-solving and the pursuit of new opportunities
• Commitment to excellence in job performance and willingness to follow through on all reasonable means to complete assigned functions in the most timely and accurate fashion possible
• Ability to attend all meetings as necessary
• An acceptable CORI (criminal record assessment)
• Knowledge of Federal and State billing regulations

Bay Cove Human Services is an Equal Opportunity Employer and does not discriminate on the basis of race, ethnicity, religion, sex, gender identity or expression, national origin, sexual orientation, disability, age, veteran status, or any other groups as protected by Massachusetts or federal law. All qualified candidates, regardless of background, are encouraged to apply.

Bay Cove Human Services does not offer visa sponsorships at this time and will require candidates to be authorized to work in the United States.

Pay Rate: $24.04/hr