Billing Specialist - IN PERSON

Job Description: Billing Specialist

Organization: Northern Ohio Recovery Association (NORA)

Website: www.norainc.org

Location: Cleveland, Ohio

Reports to: Billing Manager

Position Summary

The Billing Specialist supports NORA’s billing and revenue cycle operations by ensuring accurate

claims submission, authorization management, reimbursement monitoring, Medicaid eligibility,

accounts payable activities, and payer follow-up. The position works closely with clinical and

administrative teams to support timely reimbursement, accurate documentation, and

compliance with payer, regulatory, HIPAA, 42 CFR Part 2, and organizational requirements. This

position is expected to model professionalism, recovery principles, and prosocial behavior in all

interactions.

Key Responsibilities

Submit and monitor claims accurately and timely; identify and resolve billing discrepancies and

reimbursement issues.

Process and monitor accounts payable activities and complete required billing documentation and

reports.

Verify Medicaid eligibility for outpatient clients and maintain accurate eligibility and billing records.

Manage payer authorizations across the continuum of care, including admissions, precertification,

concurrent and continued-stay reviews, step-downs, and retrospective reviews.

Track authorization requirements, approved levels of care, units or days, effective and review dates,

authorization numbers, and payer-specific conditions.

Review clinical documentation and collaborate with treatment teams to obtain information needed

to support medical necessity and authorization requests without directing clinical care or altering the

clinical record.

Communicate clinical information to payer representatives using applicable medical-necessity

criteria and payer guidelines.

Monitor authorization deadlines and assigned cases, escalating unresolved documentation, payer, or

authorization issues before reimbursement is placed at risk.

Identify documentation gaps, adverse determinations, and potential denials; coordinate

peer-to-peer reviews, reconsideration's, appeals, and other payer escalation activities as assigned.

Prepare case summaries and supporting documentation for appeals, peer reviews, audits, and payer

follow-up.

Review payer correspondence and adverse determinations, communicate outcomes to appropriate

staff, and complete required follow-up within established deadlines.

Participate in denial review, quality audits, root-cause analysis, training, and

performance-improvement activities.

Maintain working knowledge of payer requirements, authorization processes, medical-necessity

criteria, and applicable regulatory standards.

Collaborate with Billing, Clinical, Compliance, Patient Financial Services, Utilization Review,

Admissions, and other Revenue Cycle partners.

Maintain accurate records in the electronic medical record, payer portals, tracking systems, and

other designated applications.

Protect client privacy and maintain compliance with HIPAA, 42 CFR Part 2, payer requirements,

accreditation standards, and NORA policies.

Provide professional internal and external customer service and communicate effectively with

clients, staff, payers, and regulatory entities.

Maintain compliance with NORA’s Code of Ethics and Policies and Procedures Manual.

Complete special projects and other duties as assigned.

Qualifications

Minimum two years of experience in behavioral healthcare, substance use disorder treatment,

healthcare billing, utilization review, managed care, insurance authorization, case management,

revenue cycle, or a closely related field.

Behavioral health and/or substance use disorder experience required.

Working knowledge of Medicaid billing and insurance authorization processes.

Knowledge of precertification, concurrent review, continued-stay review, authorization tracking,

payer follow-up, and appeals.

Ability to interpret clinical documentation and communicate information related to symptoms,

functional impairment, risk, treatment needs, progress, and barriers to discharge.

Knowledge of ASAM Criteria and experience with residential, inpatient, partial hospitalization,

intensive outpatient, and outpatient levels of care preferred.

Strong attention to detail, organization, documentation, and follow-through.

Ability to manage multiple cases, deadlines, and competing priorities.

Strong written, verbal, communication, and problem-solving skills.

Proficiency with billing software, electronic medical records, Microsoft Office, and payer portals.

Working knowledge of HIPAA and 42 CFR Part 2.

Demonstrated commitment to confidentiality, professionalism, ethical conduct, and NORA’s mission.

Compensation & Benefits

Competitive salary commensurate with experience.

Health, dental, and vision insurance.

Paid time off and holidays.

Professional development opportunities.

Amount of Travel

Minimal, mostly confined to the Ohio Area.

Salary Range

This is a paid position and salary will be rated based on experience