Billing Assistant, Eligibility & Denials Family Ties Enterprises, Inc. Sandy Springs, GA | Full-Time | Hybrid $40,000–$45,000 annually ($19.23–$21.63/hour), depending on experience Join Our Revenue Cycle Team Family Ties Enterprises, Inc. delivers behavioral health and community-based services to children and families across Georgia. Our mission is to equip families with the skills and resources to keep children safely at home and in their communities. Our Revenue Cycle Management (RCM) team supports this mission by securing proper authorizations, submitting accurate claims, and collecting timely reimbursement. We are seeking a Billing Assistant – Eligibility & Denials to strengthen both the front and back ends of our billing process. Role Overview This early- to intermediate-level RCM role focuses on insurance eligibility, coordination of benefits, claim denials, payer follow-up, and payment resolution. This is not solely an administrative or data-entry billing role. The successful candidate will investigate billing issues, identify solutions, take corrective action, document follow-up, and escalate complex or recurring problems appropriately. You will partner with Intake, clinical staff, authorizations, credentialing, billing team members, and insurance payers to prevent avoidable denials and move outstanding claims toward payment. This role is ideal for a healthcare billing professional seeking specialized experience in behavioral health RCM, Georgia Medicaid/CMO billing, commercial insurance, and denial management. Key Responsibilities Eligibility and Coverage Verification • Verify Medicaid, CMO, commercial, and other payer eligibility through GAMMIS, Availity, payer portals, and payer phone systems. • Confirm member demographics, coverage dates, plan type, benefit status, and payer order. • Research and resolve coordination of benefits (COB) issues to identify the correct primary payer. • Identify inactive, terminated, duplicate, or conflicting coverage. • Accurately document eligibility findings in ECN and applicable payer systems. • Notify Intake and other departments of eligibility issues to prevent avoidable denials. • Reconcile discrepancies among referral details, eligibility records, and payer information. Denial and Claim Resolution • Review denied, rejected, suspended, and unpaid claims. • Identify each denial’s cause and determine the next action. • Classify denials by root cause, including: • • Eligibility • Authorization • Credentialing • Coding • Timely filing • Documentation • Duplicate billing • Coordination of benefits • Review remittance advice and payer correspondence for required corrections. • Submit corrected claims, reconsiderations, and appeals within payer deadlines. • Follow up with payers on unpaid, pending, and denied claims. • Document payer contacts, representative names, reference numbers, claim status, next actions, and follow-up dates. • Track denials from identification through resolution. • Escalate recurring, high-dollar, or complex issues to the Billing Manager. RCM Operations and Team Support • Maintain accurate, timely billing and insurance records. • Monitor assigned follow-up queues and meet deadlines. • Identify trends in eligibility issues and claim denials. • Report recurring problems to the Billing Manager and relevant departments. • Assist with billing cleanup and special RCM projects. • Collaborate with Intake, clinical, authorization, credentialing, and billing staff. • Safeguard patient/member information in accordance with HIPAA, payer requirements, and Family Ties policies. Candidate Profile Minimum Qualifications • High school diploma or equivalent. • One to three years of experience in healthcare billing, insurance verification, claims processing, denial management, or a related RCM function. • Working knowledge of: • • Insurance eligibility • Medicaid/CMO • Commercial insurance • Coordination of benefits • Authorizations • Claim denials and rejections • Strong attention to detail and accuracy. • Ability to manage competing priorities and payer deadlines. • Strong problem-solving and follow-through. • Professional written and verbal communication skills. • Proficiency in Microsoft Office, especially Excel. Preferred Experience Strong candidates will demonstrate proficiency with GAMMIS, Availity, and similar payer portals, as well as an EHR or billing system. Preferred experience includes Georgia Medicaid behavioral health billing, Georgia Medicaid CMOs, DBHDD-funded behavioral health services, CMS-1500 claims, electronic and paper claim submission, and Medicaid/CMO authorization and utilization management. An associate degree or relevant coursework in healthcare administration, business, or medical billing is strongly preferred. Benefits • 401(k) • Health Insurance • Dental Insurance • Vision Insurance • Paid Time Off • Referral Program