ABA/In-Patient Billing Specialist

ABOUT RYTHER:
Helping children, youth, young adults, and their families find their path to healing and hope is at the core of our work. We can only achieve this by striving for excellence and providing an array of services that are needed and wanted by the community we serve. We are continuing to expand our service array and locations where we provide services, with therapists in more schools and social service agencies. As we expand our services to serve more than 800 children, youth, and young adults each month – regardless of payer, gender identity, sexual orientation, race or ethnicity, or place of origin – we do so with the intention that we would want our own families to use these services should they need them. The staff at Ryther are committed to creating and maintaining a culture that is informed and reflective of trauma recovery and racial equity and social justice principles.

ABOUT THE ROLE:

The ABA/In-Patient Billing Specialist is responsible for many of the billing aspects for our ABA program and In-Patient services for our IOP and SAC programs. Ensure timely payments from insurance carriers and other payors.  Provide regular financial reports to management.

KEY AREAS OF RESPONSIBILITY:

  • Verify eligibility and benefits for assigned services.

  • Research and obtain necessary pre-certifications/pre-authorizations for said services.

  • Assist the Lead Admissions, Insurance, and UR Coordinator with contracting and credentialing of specialty services and providers as needed.

  • Ensure that all clients receiving assigned services have up to date and accurate demographic and insurance information.

  • Audit data to ensure all claims for assigned services are clean.

  • Create batches and submit claims for all assigned services.

  • Review posted payments for pending or denied claims for all assigned services.

  • Check claim status on appropriate payor systems and contact insurances as needed.

  • Investigate and file an appeal for insurance denials or underpaid claims on assigned services.

  • Review and resolve rejected claims.

  • Conduct calls with clients to review A/R and troubleshoot any billing issues.

  • Timely follow-up with clients and insurances on missing payments or to resolve financial discrepancies.

  • Help clients of assigned services develop patient payment plans, as needed.

  • Work with Medical Records department on requests for Medical Records for assigned services and other documentation from payors, as requested.

  • Assist Insurance Coordinator with obtaining Single Case Agreement (SCA) for out-of-network insurance companies to pay services at in-network rates for clients seeking assigned services, as needed.

  • Review appropriate daily/weekly/monthly reports for assigned services.

  • Meet billing metrics for each assigned service.

  • Demonstrate a high degree of skill in communication and positive interaction with all Ryther employees, prospective employees, external agencies/companies and the community at large.

  • All other duties as assigned.

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ESSENTIAL JOB REQUIREMENTS

  • 3+ years of ABA and/or inpatient billing and collections experience in Washington.

  • Billing certification/degree preferred but not required.

  • Experience/working knowledge in all aspects of Revenue Cycle Management.

  • Experience in medical billing preferred.

  • Knowledge of commercial insurance and government payor guidelines.

  • Working knowledge and/or training of insurance benefits and reimbursement.

  • Proficient in medical terminology, HIPAA and other critical governmental regulations.

  • Exceptional customer service skills as communicating with clients, providers, staff, and various insurance companies will form a large part of the job.

  • Ability to multi-task and meet deadlines.

  • Ability to comprehend various insurance documentation, analyze and reconcile accounts and follow detailed procedures in an organized and efficient manner.

  • Superior problem-solving and follow-up skills.

  • Strong computer skills (Word, Excel, SharePoint, EHR-billing software, such as Credible).

  • Working knowledge of using a clearinghouse for electronic claims submission.

  • Ability to exercise discretion and maintain both client and employee confidentiality in accordance with HIPAA, contract requirements, or other applicable laws and regulations.

  • Ability to use near constant use of keyboard for typing or 10-key entry.

  • Frequent use of telephone and emails.

  • Occasional use of video conferencing, copying, faxing/scanning.