Lead Billing Specialist

Groups is a leading outpatient provider specializing in substance use disorder (SUD) treatment. We are committed to supporting underserved communities hit hardest by the opioid crisis. Since 2014, our local care teams have guided hundreds of thousands of individuals on their path to recovery, helping them reclaim their purpose and dignity through compassionate, collaborative care.

Our evidence-based approach combines medication, group therapy, and personalized support, delivered online and in person by local providers. Founded on the belief that recovery extends beyond the traditional office visit, Groups helps members build a foundation for long-term recovery and the fulfilling lives they want and deserve. 

Together with our community partners, public agencies, and health plans, we are raising the bar in addiction health care—and we’re just getting started. 

Groups is changing lives. Join us.

The Lead Medical Billing Specialist (Lead Claims Specialist) is responsible for managing all aspects of the claims lifecycle, from claim submission to resolution, including appeals, follow-ups with payers, and denial management. This role is essential in ensuring accurate and timely reimbursement for services rendered by our providers.

Essential Functions:

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Identify, investigate, and resolve unpaid claims. Utilizing Payor portals to follow up on submitted claims.
• Initiate and manage follow-up communications to commercial and government payers to resolve denied, delayed or unpaid claims, ensuring timely reimbursement and compliance with payer-specific requirements.
• Researching denials and rejections as well as payor policies.
• Submit claims’ reconsiderations and appeals. Documenting account activity. Managing medical records requests.
•  Monitor, track and analyze payor-related issues and denial trends to identify patterns and trends. 
• Supervise and support Medical Billing Specialists.
• Collaborate with Billing, Cash Posting, Contracting and Intake on issues affecting account resolution.

Other Duties and Responsibilities:

• Other duties as assigned.

Knowledge, Skills and Abilities:

• Knowledge of CPT, HCPCS, ICD-10 coding, and payer rules related to behavioral health services.
• Knowledge of insurance plans, policies, and procedures.
• Understanding of payment reconciliation and basic accounting practices.
• Proficiency in using EHR systems and insurance verification software.
• Proficiency in Zoom/Google Meets and other virtual meeting platforms
• Strong organizational and multitasking skills.
• Excellent verbal and written communication skills.
• Ability to use discretion and work independently under general supervision.
• Ability to work as part of a team
• Ability to handle sensitive member and payment data in compliance with regulatory standards.
• Ability to provide coaching, training and performance feedback to Medical Billing Specialists.
• Detail-oriented with a high level of accuracy.

Qualifications & Requirements:

• High school diploma or equivalent; associate's degree or relevant certification preferred. 
• CPC Required. 
• Minimum of 5-10 years of experience in following up/resolving outstanding medical claims.
• Access to reliable internet and telephone services, specifically 40M download and 10M upload package or higher as well as a strong WiFi signal from your remote work location.
• Must meet pre-employment requirements and maintain all applicable state and job-related guidelines for background screening. 

Physical Requirements & Working Conditions:

These physical demands are representative of the physical requirements necessary for an employee to successfully perform the essential functions of the job. Reasonable accommodation can be made to enable people with disabilities; these are made on a case-by-case basis.

While performing the responsibilities of the role, the employee is required to talk and hear. The employee is often required to sit and use his or her hands and fingers.  The employee is occasionally required to stand, walk, and reach with arms and hands. Vision abilities required by this job include close vision.

Limitations and Disclaimer:

The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.  Other duties may be assigned from time to time.

Equal Employment Opportunity Statement:

Groups is an equal opportunity employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision.