Mental Health Billing Specialist

Qualifications

• High school diploma or equivalent required
• Minimum of 4 years of relevant experience in mental health medical billing, healthcare revenue cycle, claims processing, insurance verification, and/or data entry
• Medical billing or coding certification preferred
• Experience with Electronic Health Record (EHR) systems; Credible experience strongly preferred
• Experience with Waystar, Carelon, Availity, EVS, and Novitsphere preferred
• Knowledge of Medical Assistance, commercial insurance, authorization requirements, claims processing, denials, and coordination of benefits
• Proficiency with Microsoft Office Suite, including Word, Excel, and Outlook
• Strong organizational and time-management skills
• Excellent attention to detail and accuracy
• Ability to prioritize multiple assignments and meet deadlines
• Strong analytical, research, and problem-solving skills
• Excellent written and verbal communication skills
• Strong customer-service skills and the ability to communicate professionally with persons served, insurance companies, clinical staff, and internal departments
• Ability to work independently with minimal supervision while contributing effectively as part of a team
• Ability to maintain confidentiality and appropriately handle sensitive financial and personal information

Key Responsibilities

• Track, request, obtain, and enter insurance authorizations for Medical Assistance and commercial insurance plans across outpatient mental health, residential, supported employment, and substance abuse programs
• Submit and manage authorization requests through the Carelon Provider Portal
• Monitor authorization status and follow up on denials, pending requests, expirations, and requests for additional clinical information
• Initiate, review, and monitor claims through the Credible EHR/billing platform
• Review claims for accuracy and completeness before submission and identify issues that could result in rejection or denial
• Research, resolve, document, and track claim discrepancies, rejections, denials, and payment issues
• Monitor claim status and communicate with insurance payers and clearinghouses to support timely reimbursement
• Verify Medical Assistance eligibility for residential and outpatient persons served and address eligibility issues as needed
• Receive, record, and accurately post payments, including cash, checks, and credit card payments
• Issue monthly statements and respond professionally to billing questions, account inquiries, and complaints
• Maintain accurate and organized billing records and documentation
• Provide backup support for billing, claims processing, authorization, data entry, and other revenue-cycle functions
• Collaborate with clinical, administrative, finance, and billing staff to resolve authorization, eligibility, claims, and account-related issues
• Maintain confidentiality and comply with HIPAA, payer, organizational, and billing requirements
• Stay current with healthcare regulations, insurance requirements, billing procedures, and payer guidelines
• Perform other billing and administrative duties as assigned

This role offers the opportunity to use billing and revenue-cycle expertise in a mission-driven behavioral health organization. The work directly supports the financial health of the organization and helps ensure that services can continue to make a meaningful impact.