Billing & Claims Specialist

TSGBH is seeking a reliable and detail-oriented Billing & Claims Specialist to support our behavioral health billing operations.

This position is ideal for someone who has experience working with U.S. healthcare claims, insurance billing, Medicaid, claim follow-up, and payment reconciliation .

Your primary responsibility will be making sure services that have been provided are properly billed, claims are followed through to payment, and billing problems are identified and resolved quickly.

This is not simply a data-entry position. We need someone who can review a claim, identify why it has not been paid, and take the appropriate next step.

Key Responsibilities

• Submit and monitor insurance claims
• Review claims for accuracy before submission
• Track unpaid, pending, rejected, and denied claims
• Follow up with insurance companies and managed care organizations regarding claim status
• Review EOBs, ERAs, and payment information
• Identify claim denials and rejection reasons
• Correct and resubmit rejected or denied claims when appropriate
• Maintain an organized list of outstanding claims
• Post or reconcile insurance payments as assigned
• Verify that services documented have been billed
• Identify missing documentation that may prevent billing
• Identify authorization or eligibility problems affecting claims
• Communicate billing issues to management and clinical/administrative staff
• Maintain accurate notes regarding claim follow-up activity
• Assist with accounts receivable and aging reports
• Escalate claims that require additional intervention
• Protect confidential patient information and follow HIPAA requirements

What We Are Looking For

Healthcare billing experience is strongly preferred.

You should understand or have experience with:

• U.S. healthcare insurance billing
• Behavioral health or mental health billing
• Medicaid claims
• CMS-1500/professional claims
• Claims submission
• Denials and rejections
• EOBs and ERAs
• Accounts receivable
• Insurance eligibility
• Prior authorizations
• Claim status follow-up
• Payment reconciliation

Skills Needed

The right person must be:

• Extremely detail-oriented
• Organized
• Comfortable working independently
• Good at researching billing problems
• Able to follow a claim from submission through payment
• Comfortable communicating professionally by email and telephone
• Able to document their work clearly
• Able to recognize when something does not look correct
• Reliable and consistent with attendance
• Comfortable working during U.S. Eastern Time hours

Strong written English and professional communication skills are required.

Performance Expectations

We are looking for someone who takes ownership of the billing process.

You should not simply report that a claim was denied.

We expect you to determine:

Why was it denied?
Can it be corrected?
What information is missing?
Who needs to take action?
What is the next step?

Our goal is to maintain clean claims, reduce denials, follow up aggressively on outstanding balances, and make sure the company receives payment for services that have been properly provided.

Compensation

Starting Pay: $3.50 USD per hour with Bonus

This is intended to be a long-term position for the right candidate. Performance, reliability, accuracy, and demonstrated ability to manage claims independently will be considered during future compensation reviews.

How to Apply

Please submit the following:

1. A brief introduction about yourself.
2. Describe your previous U.S. healthcare billing experience.
3. What types of insurance or Medicaid claims have you worked with?
4. Have you worked with behavioral health or mental health billing?
5. What billing or EHR systems have you used?
6. Describe how you would handle a claim that was submitted but has not been paid after 30 days.
7. Describe a denial you have handled in the past and how you resolved it.
8. Confirm that you are available to work during U.S. Eastern Time.

Applications that do not answer the questions above will not be prioritized.

We are looking for someone who wants to learn our organization, take ownership of our claims, and become a dependable long-term member of our administrative team.