PRE-BILLING QUALITY SPECIALIST

Pre-Billing Quality SpecialistPosition SummaryThe Pre-Billing Quality Specialist ensures that all billing across IDD (Intellectual and Developmental Disabilities) and BHH (Behavioral Health Home) programs meets payer and regulatory requirements prior to claim submission. This role verifies that all services are fully supported by accurate documentation, appropriate authorizations, and correct utilization.The Specialist proactively identifies and resolves issues that may delay or prevent billing, working closely with Program teams and Revenue Cycle Management (RCM) to ensure timely and accurate reimbursement.Key ResponsibilitiesPre-Billing VerificationReview service documentation to ensure compliance with payer-specific billing requirementsVerify completion of all pre-billing steps, including:Documentation completionService entry accuracyAuthorization validationUnit totalsConfirm required elements such as:SignaturesTimelinesService codes and modifiersUtilization limitsIdentify and coordinate correction of missing or inaccurate documentationClaims Preparation & Issue ResolutionValidate service data, authorizations, and payer information prior to claim submissionIdentify and resolve pre-billing issues such as data discrepancies and authorization conflictsCollaborate with Program leadership and RCM to address:DenialsReturned claimsTrack denial trends and support implementation of corrective actionsUtilization & Authorization MonitoringTrack service utilization to prevent exceeding authorized limitsMonitor authorizations for accuracy in:UnitsService codesEffective datesNotify program staff of discrepancies or upcoming expirationsReporting & Data AnalysisGenerate and analyze reports from systems such as:AvatarSetWorksTherapBHLProduce KPI and pre-billing reports to identify trends and outstanding issuesValidate billing-related data across multiple EHR platformsEnsure documentation supports all billed servicesTraining & Process ImprovementTrain program staff on billing requirements, documentation standards, and system processesCommunicate findings and issues clearly to program teams and RCMRecommend workflow improvements to enhance accuracy and reduce denialsAdministrative SupportAssist in evaluating and improving workflows related to:Pre-billing and billing processesConsumer change formsOpening/closing service locationsPerform additional duties as assigned by leadershipQualificationsEducation & ExperienceHigh School Diploma or GED required; Associate's degree preferredValid Driver's License minimum of three years.2+ years of experience in:Behavioral Health, IDD, or Medicaid-funded billingStrong knowledge of:Medicaid billing processesDenials managementEHR systems and reporting toolsTechnical SkillsAdvanced proficiency in Microsoft Excel, including working with large datasetsExperience navigating multiple EHR systemsKnowledge of billing software and reporting toolsCore CompetenciesStrong attention to detail and accuracyExcellent organizational and time-management skillsAnalytical and problem-solving abilitiesEffective written and verbal communicationAbility to manage multiple priorities and meet deadlinesAbility to work independently and collaborativelySolution-oriented mindset with a focus on continuous improvementWorking Conditions & RequirementsWork is primarily performed in a professional office environmentAbility to sit for extended periods and use standard office equipmentOccasional lifting, bending, and movement as requiredMust comply with:HIPAA regulationsOSHA and safety standardsOrganizational policies and proceduresABOUT THE COMPANY:Apis Services, Inc. (a wholly owned subsidiary of Inperium, Inc.) provides a progressive platform for delivering Shared Services to Inperium and its Constellation of affiliate companies. Allowing these entities to advance their mission and vision. By exploring geographical program expansion and focusing on quality outcome measures to create cost savings that result in reinvestment into the organizations stakeholders through capacity creation and employee compensation betterment.