Purpose The Billing Specialist is a vital member of the RCM Department, responsible for managing the full lifecycle of ABA claims billing and follow-up. This role ensures that claims are submitted accurately and timely, payments are properly posted and reconciled, and denials are addressed promptly. The Billing Specialist works collaboratively with providers and internal teams to maintain a clean accounts receivable and maximize revenue collection.

This role is adecuado for someone who is detail-oriented, proactive, and comfortable navigating the complexities of medical billing in a fast-paced, supportive team environment.

Accountabilities The ongoing work others can expect from this role — the activities it manages and enacts in service of other roles and its own purpose.

Daily

- Submit accurate and timely primary and secondary claims.
- Post insurance payments and reconcile payment data.
- Monitor and resolve claim rejections; escalate for assistance as needed.
- Work claim denials — all denials must be addressed within 3 days of remittance advice posting.
- Monitor and address assigned tasks in the system, including provider communications.
- Respond to billing-related emails and inquiries.

Weekly

- Ensure all payments for the week have been posted and reconciled.
- Confirm resolution of all claim rejections; escalate unresolved issues.
- Review for any missed billing (e.g. late service entries, resolved claim holds).
- Follow up on previously worked denials for updates (2 weeks from worked date).
- Identify and report developing claim issues or patterns, escalating to leadership when needed.

Monthly





- Review the prior month's services for any missed billing opportunities.
- Investigate unpaid claims with no payer response; confirm claim is on file.
- Rebill claims not on file and review the ERA module for any missing remits.
- Track and follow up on claims over 60 days old, ensuring appropriate action has been taken.
- Review and manage overpayments, initiate recoupment processes when necessary, and ensure payers post reconciliations appropriately.

Quarterly

- Audit each month in the quarter for missed billing and unacknowledged claims.
- Rebill missing claims and ensure ERA remits are accounted for.
- Validate overpayments have been resolved and payments posted.
- Continue payer project follow-ups (e.g. chronic underpayments, OON processing errors).

Annual

- Coordinate with providers to write off uncollectable claims after a thorough appeals process.
- Categorize write-offs by reason (e.g. timely filing, medical necessity, coverage issues, duplicate billing).
- Ensure appeals have been exhausted before writing off balances.

Competencies The skills required to perform this role competently.

Personal qualities

- Resilient
- Hard working
- Honest
- Reliable

Skills

- Detail-oriented with a high level of accountability and follow-through.
- Strong communication and problem-solving skills.

Qualifications & Experience

- Experience in ABA or behavioral health billing preferred.
- Strong understanding of the medical claim lifecycle and payer reimbursement processes.
- Prior experience in Medicaid billing.
- Experience in the ABA industry is preferred.
- Familiarity with ERA/EOB processing and electronic claim submissions.

📌 AR Billing Specialist | Work from Home (Colombia)
🏢 Spoke
📍 Colombia