Billing Specialist

Position Summary

The Behavioral Health Billing Specialist is responsible for accurately and efficiently processing behavioral health claims, maintaining billing records, following up on unpaid or denied claims, and supporting the organization's revenue cycle. This position works closely with clinical, administrative, and insurance personnel to ensure services are properly documented, coded, billed, and reimbursed in a timely manner.

The Billing Specialist must maintain confidentiality and comply with HIPAA, payer requirements, organizational policies, and applicable federal and state regulations.

Essential Duties and ResponsibilitiesBilling and Claims Processing

• Review patient accounts and documentation for billing accuracy and completeness.
• Enter and submit insurance claims accurately and within required billing timeframes.
• Verify that services are supported by appropriate documentation and authorization.
• Review claims for correct patient information, insurance information, dates of service, provider information, diagnosis codes, procedure codes, and modifiers.
• Submit electronic and, when necessary, paper claims to commercial insurance companies, Medicaid, Medicare, and other third-party payers.
• Monitor claim status and follow up on outstanding claims.
• Correct and resubmit rejected or denied claims as appropriate.
• Maintain accurate records of claim submissions, payments, adjustments, denials, and follow-up activities.

Insurance Verification and Authorizations

• Verify patient insurance eligibility and benefits as needed.
• Identify applicable copayments, deductibles, coinsurance, and other patient financial responsibilities.
• Assist with obtaining and tracking required prior authorizations and service approvals.
• Monitor authorization dates and units to help prevent billing interruptions or non-covered services.
• Communicate insurance-related issues to appropriate clinical and administrative staff.

Accounts Receivable and Denial Management

• Review accounts receivable reports and prioritize outstanding balances for follow-up.
• Investigate unpaid, partially paid, and denied claims.
• Identify trends in denials and communicate recurring billing issues to management.
• Prepare corrected claims, appeals, reconsiderations, and supporting documentation when appropriate.
• Post insurance payments, patient payments, contractual adjustments, and other account transactions accurately.
• Assist with reducing aged accounts receivable and maintaining established collection goals.

Pay: From $15.00 per hour

Expected hours: 15.0 per week

Work Location: Remote