The Billing Specialist is responsible for the accurate, timely, and compliant submission and management of claims for behavioral health and mental health services. This role supports the agency's revenue cycle by ensuring services are properly billed, payments are posted and reconciled, denied or rejected claims are addressed, and outstanding accounts receivable are monitored.
The position works collaboratively with clinical, administrative, credentialing, authorization, and quality management staff to resolve issues that could prevent accurate and timely reimbursement.
Key duties include preparing and submitting claims, verifying eligibility and coverage, reviewing claims for coding accuracy, monitoring denied or unpaid claims, posting payments and adjustments, following up on outstanding claims, maintaining billing records, assisting with audits and payer reviews, and reporting recurring billing concerns to management.
Experience
- Minimum of one year of behavioral health billing experience preferred
- Experience with North Carolina Medicaid, NCTracks, Medicaid Managed Care, Tailored Plans/LME-MCOs, behavioral health billing, or similar payer systems strongly preferred
Knowledge and Skills
- Working knowledge of NC Medicaid requirements, applicable MCO requirements, commercial insurance requirements, and Medicare requirements when applicable
- Ability to review claims for accurate service codes, modifiers, units, dates of service, diagnosis codes, and rendering provider information
- Familiarity with EOBs, ERAs, payment posting, denials, recoupments, and accounts receivable follow-up
- Understanding of HIPAA, 42 CFR Part 2 when applicable, and billing compliance requirements
Location
North Carolina, US
Employment Type
Part-time
Experience Level
Entry Level
Remote work allowed
No
Posted
2 weeks ago