Medical Billing Specialist, Hybrid Remote Full-Time

Swank Early Skills Development (SESD) is a boutique behavioral health company providing ABA therapy to children 6 and under in Lancaster County, Pennsylvania. We are preparing to grow our business over the next five years as we are implementing a strategic growth plan, and we need an experienced and motivated Medical Billing Specialist who can work with minimal supervision. You will need at least three (3) years of experience as a full-time medical billing specialist and experience billing medical assistance (MA). You must be fluent in Excel and familiar with QuickBooks. Preference will be given to those with experience in behavioral health or applied behavior analysis billing.

This position has tremendous growth potential.

All new hires have a 90 day probationary period to show their skills and work ethic. At the 90 day review, employees may re-negotiate their compensation based on their ability to provide considerable value to the company when proven in data and detailed review of the job requirements listed below.

During the 90 day probationary period, employees must be onsite, but they have the option to choose their hours as long as there is overlap with their supervisor. After 90 days, the option to work remotely and with flexible hours is available. Overtime will be available for special projects.

Starting Compensation:

• Hourly rate $23 to $28 - depending on training and experience
• 15 Days Paid Time Off- accrual based after 90 days
• 5 Days Unpaid Time Off
• 10 Paid Holidays Upon Hire – 9 company holidays, 1 floating day of your choice
• Performance based raises
• Intermittent bonuses
• Informal profit sharing
• Company referral bonuses

• Medical Insurance – employer pays 50% of employee premium
• Dental Insurance
• Vision Insurance
• Life Insurance – employer provided at no cost
• Short Term and Long Term Disability – employer provided at no cost
• Simple IRA Retirement Plan Option Upon Hire -employer matches employee contribution equal to salary reduction contributions up to a limit of 3%

• Submit insurance claims (primary, secondary and tertiary) across appropriate funder portals at least weekly and within required “timely filing” guidelines to ensure consistent revenue cycle
• Monitor and problem solve claim denials, resolutions and resubmissions
• Monitor outstanding claims balances and outstanding revenue
• Create, send and follow up on invoices to collect financial obligation of the client
• Obtain, maintain, and distribute information about prior authorization for client services to clients, clinicians and operations team members
• Enter authorizations in designated client tracking system
• Process clinician credentialing
• Monitor client services fulfillment and create communication workflow to update clinicians
• Transfer tracking system data from Excel to Quickbooks
• Provide support to the greater operations and clinical team members with authorization updates, claims status reports and outstanding revenue reports
• Process initial benefits verifications and communicate with families regarding findings
• Monitor client active benefits through regular EVS checks
• Assist families with coordination of benefits and insurance concerns
• Maintain information on claims processing procedures and step by step guidelines for claims monitoring for all funders
• Monitor claims payments and ensure that payout rates align with funder fee schedules
• Works independently to ensure streamlined processes and increase efficiency

• Works collaboratively with other members of the Operations Team to ensure cohesive and efficient processes and outcomes.
• Uses strong problem-solving skills and initiative to remove barriers and provide more services to our clients.
• Multi-tasks and shifts easily between various tasks as needed, following up on unfinished projects in a timely manner
• Handles sensitive company documents and information with the utmost privacy and security as per company procedures, following both HIPAA and FERPA regulations as they apply.
• Demonstrates the ability to effectively and efficiently use Microsoft Office Word, Excel, and other Office Products in the engagement of data collection, tracking, report writing, and other activities that are needed in this role.
• Demonstrates the ability to quickly learn and begin to use other software required for the execution of business in the company as it arises.
• Demonstrates the ability to effectively and efficiently manage documentation systems related to contract fulfillment, contract compliance, invoicing, and payment processing.
• Demonstrates excellent verbal and written communication skills: the ability to communicate professionally and positively with coworkers, clients, and contacts that the company receives from the outside.
• Effectively communicates with potential clients, clients, business associates, and co-workers with positivity and compassion through all means of communication.
• Handles challenging conversations with clients and insurance providers with positive firmness and respect.
• Effectively decides when situations need to be elevated to members of management.

• Using a physical key to unlock and lock Company doors, filing cabinets, and other locked storage facilities or devices.
• Looking at a computer / electronic device screen for most of the workday.
• Typing / keyboarding for most of the workday.
• Sitting at a computer for most of the workday.
• Vocally communicating with people frequently throughout the workday.

• High School Diploma/GED required (College Degree preferred)
• Skilled with Excel & QuickBooks

• At least three (3) years of continuous and proven experience as a medical billing specialist, preferably in a Behavioral Health environment
• Experience with medical assistance (MA) billing
• Strong mathematics skills and a good command of the English language
• Ability to process financial information quickly and accurately
• Strong knowledge of health insurance providers, including medical assistance
• 3 positive professional reference checks, including one from former/current direct supervisor
• Can produce “clear” PA required clearances (PA Child Abuse Clearance, PA State Criminal Check, FBI Fingerprint Clearance) valid within 1 year of hire date
• TB Test
• Mandated Reporter training
• Proof of Eligibility to work in the U.S.

• Certified in Billing and Coding
• College degree or further education in the skills required for the role
• Ability to create & monitor metrics and KPIs
• Experience in process improvement or workflow design
• Experience in Behavioral Health or Applied Behavior Analysis (ABA) billing and authorizations

Come Join Our Team!

Swank Early Skills Development LLC is an Equal Employment Opportunity/Affirmative Action Employer and does not discriminate on the basis of race/color, religion, sex, sexual orientation, gender identity, national origin, medical history, protected veteran status, disability or any other legally protected status. This role is non-exempt.