Experience in Behavioral Health strongly preferred
Join our dynamic team as a Medical Billing, Coding, and Utilization Review Specialist, where your expertise will support accurate reimbursement, insurance compliance, and effective management of medical records for our mental health and substance use facility. In this vital role, you will be responsible for translating healthcare services into precise billing codes, managing claims submissions, supporting utilization review processes, and maintaining detailed medical documentation. Your attention to detail, understanding of insurance requirements, and ability to review clinical documentation for medical necessity will contribute to the efficiency of our operations while supporting both quality patient care and the financial health of the organization.
Duties include reviewing and analyzing medical records to assign appropriate ICD-10, CPT, HCPCS, and other applicable billing codes; preparing and submitting insurance claims accurately using EMR/EHR systems; following up on unpaid, denied, or rejected claims; conducting and supporting utilization review activities; submitting authorizations and concurrent reviews; communicating with insurers regarding claims and authorizations; ensuring clinical documentation supports billed services and meets payer requirements; tracking authorization dates and limits; assisting with denial management and appeals; maintaining detailed documentation for audit readiness; collaborating with clinical staff to clarify diagnoses and documentation; and ensuring compliance with coding guidelines, payer policies, HIPAA, Medicaid/Medicare standards, and other healthcare regulations. Stay updated on changes in medical terminology, coding standards, insurance policies, authorization requirements, and utilization management practices.
Skills required include strong knowledge of ICD-10, CPT, and HCPCS coding systems; behavioral health and substance use disorder billing knowledge preferred; understanding of utilization review, prior authorizations, medical necessity documentation; proficiency in billing processes, claims submission, denial follow-up, and collections; experience with EMR/EHR systems; strong medical terminology and records management abilities; familiarity with coding and billing regulations; strong organizational skills; effective communication skills; high attention to detail for accurate record maintenance.
Strong knowledge of ICD-10, CPT, and HCPCS coding systems Knowledge of behavioral health and substance use disorder billing preferred Understanding of utilization review, prior authorizations, concurrent reviews, continued stay reviews, and medical necessity documentation Ability to interpret clinical documentation and determine whether services are supported by diagnosis, treatment plan, level of care, and payer requirements Proficiency in medical billing processes, claims submission, denial follow-up, and collections Experience working with EMR/EHR systems for documentation, billing, authorization tracking, and claim submission Excellent understanding of medical terminology and medical records management Familiarity with healthcare regulations related to coding, billing, utilization review, payer compliance, HIPAA, Medicaid, and Medicare Strong organizational skills to track deadlines, authorizations, units, and documentation requirements Effective communication skills for collaborating with clinical providers, administrative staff, insurance companies, and managed care organizations High attention to detail and ability to maintain accurate records for audits, reviews, and compliance purposes
Location
Louisville, Kentucky, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$62,400 - $62,400
Remote work allowed
No
Posted
2 months ago