Billing Specialist

About Soar: Soar Autism Center is an innovative healthcare provider at the frontlines of the autism care landscape, a market with substantial unmet need. Soar is building a network of clinics where children with autism and their families receive life-shaping services that support them to thrive. We are building a differentiated service offering for families, advancing the standard of care in a rapidly growing market.

Specifically, we provide integrated and comprehensive services to children 6 and under with autism. Our care model is focused on a hyper-specialized form of autism therapy called the Early Start Denver Model, or ESDM, one of the most research-tested approaches in ASD care yet one of the hardest modalities to find, in an integrated care team format. We craft individual therapy plans in deep coordination with families, setting goals that are ambitious and focusing on building skills that enable children to grow into their fullest selves. We provide care in a state of the art, autistic-friendly facility, with the goal that a child’s time at the center mirrors an early childhood learning experience. We prioritize early intervention, comprehensive supportive services, and positive, developmentally-appropriate learning that meets the needs of each unique child and family.

We have opened ~30 clinics in our 4-year history across Colorado, Arizona, and Pennsylvania, all of which have quickly reached capacity and typically run with waitlists. We are now focused on scaling our platform across more areas and are looking to hire a leader for our Revenue Cycle function to support our growth over the next several years. Join us as we strive to advance the standard of care in autism therapy today!

More information available at http://soarautismcenter.com/.

About the Job: The Billing Specialist will be joining a team of RCM specialists and will be responsible for a number of areas within the RCM department. This can include but is not limited to owning primary and secondary claim generation, payment posting, patient invoicing, working claims in accounts receivable, and managing the team’s shared inbox.

The ideal candidate is someone who wants to build a strong understanding of detailed revenue cycle processes, build proficiency in CentralReach (Soar’s EMR/practice management platform), and is willing to drive relentless execution in their lane.

Key Areas of Oversight and Responsibility:

The Billing Specialist directly owns critical components of the Billing lane. Given Soar’s exciting growth trajectory, the specific responsibilities may shift depending on business needs and the need to cross-train teammates to ensure all RCM Billing teammates develop and maintain a robust, holistic knowledge of the lane. Responsibilities will cover portions of the details outlined below and may shift over time.

Primary & Secondary Claim Generation:

• Audit billing entries for accurate coding and modifiers

• Audit billing entries for diagnosis, authorization, provider and location

• Identify and flag pre-claim Medical Unlikely Edits (MUE’s)

• Send secondary claims once primary has fully adjudicated and paid their portion

• Send claims through the clearinghouse

• Audit clearing house for rejections, correct claims and send

Payment Posting:

• Reconcile electronic payments received in practice management software (CentralReach)

• Accurately label denials and claims ready for secondary billing

• Retrieve EOB’s/ERA’s from payor portals for manual posting

• Evaluate, troubleshoot, and communicate with payors on claims that have been denied

• Review & interpret payor contracts/rules to ensure accurate coding on all claims

• Work cross-functionally with team members to resolve any discrepancies preventing claims being paid related to appointments, insurance, authorizations, etc.

• Stay up to date and research specific payor billing rule changes and update internal resources accordingly

• Understand and monitor key metrics related to work performance

• Team mentality. Foster a positive work environment for colleagues

• Ensure strict HIPAA-compliant confidentiality with all client-related data

Patient Invoicing:

• Ensure the accurate and timely creation and sending of patient invoices

• Liaise with team members and clients to explain patient benefits and charges

A/R Specialist:

• Manage Soar’s backlog of denied and pending claims to ensure RCM team metrics focused on A/R aging is consistently at/above target, including

• Fix and resubmit denied claims in a timely manner and in rare circumstances, coordinate with the VP of RCM to write-off certain claims

• Conduct root cause analysis on drivers of denied claims and regularly provide suggestions on ways to improve the RCM team’s “1st pass clean claim rate”

Qualifications:

Education:

• Bachelor’s degree required (or equivalent work experience)

Experience:

• Minimum 1+ years providing therapy or working in operations in an integrated autism care setting

• A proven top performer in current and previous roles

• Experience working with analytical tools such as excel or googlesheets to create models to support various analyses

• Experience managing complex processes impacting multiple stakeholders

Skills:

• Proficient in excel or googlesheets

• Strong interpersonal skills, capable of effectively collaborating with cross-functional teams and external payors

• Exceptional attention to detail, critical thinking, and excellent communication with clients and insurance companies

Compensation and Benefits:

• Total annual compensation range:$61,000 - $66,000

• Base: $55,000 - $60,000 per year

• Bonus: Up to $6,000 (paid monthly in increments of up to $500) based on RCM team performance against monthly metrics

• Benefits: Comprehensive package including medical, dental, vision, 401(k) with match after a year of service, 10 days PTO, and professional development opportunities

• Travel: 100% Remote-based role with the opportunity to travel as needed to clinics or team meetings

Overview of Interview Process:

The interview process is approximately structured in the following steps. Candidates may be moved onto each subsequent step based on performance in the prior step, subject on the hiring manager’s discretion:

• Resume review

• Offline googlesheets based exercise

• Behavioral interview

• Offline case study

• Case study presentation

Join Soar Autism Center in transforming autism care and enhancing the lives of children and families nationwide!

Soar Autism Center is committed to diversity and inclusion at all levels. As an equal opportunity employer, we strictly prohibit discrimination or harassment and welcome applicants of all backgrounds, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability, or other protected characteristics.

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