Position Summary
The Behavioral Health Billing and Coding Specialist manages accurate coding, timely claims submission, and payment resolution for Angel Kids Pediatrics’ behavioral health services. This experienced, certified professional supports the revenue cycle from insurance verification and authorization through claim resolution and account reconciliation. The role partners with behavioral health leadership, billing staff, clinicians, and front desk personnel to reduce billing errors and support timely patient access.
Key Responsibilities
- Review and submit claims for psychological and developmental testing, diagnostic evaluations, individual and group therapy, and collaborative care or care coordination services.
- Validate CPT, HCPCS, and ICD-10-CM coding, modifiers, units, time requirements, rendering providers, and payer-specific billing rules.
- Review documentation for billed services and identify missing information before submission.
- Verify behavioral health eligibility and benefits, including deductibles, copayments, coinsurance, service limits, referrals, and telehealth coverage.
- Prepare, submit, and track prior authorization requests and renewals.
- Resolve claim rejections, denials, underpayments, and unpaid claims through follow-up, corrected claims, reconsiderations, and appeals.
- Post and reconcile payments, contractual adjustments, remittance information, and unpaid balances.
- Review aging and unbilled encounter reports and provide leadership updates on collections, denials, authorization turnaround times, and unresolved revenue cycle issues.
- Respond to family billing questions and explain statements, coverage, and financial responsibility.
- Maintain accurate billing records and support payer audits, documentation reviews, and corrective actions.
Requirements & Qualifications
Required Qualifications
- High school diploma or GED.
- At least 3 years of medical billing and claims experience, including at least 2 years of direct behavioral or mental health billing and coding experience.
- Current certification in behavioral health billing or coding, or an active nationally recognized billing or coding credential such as CPC, CPB, CCS, or CCSP with documented behavioral health billing and coding training.
- Experience billing psychological testing and psychotherapy with working knowledge of behavioral health CPT, HCPCS, ICD-10-CM, modifiers, timed services, claim edits, and documentation requirements.
- Experience with commercial insurance, Medicaid managed care, eligibility and benefits verification, prior authorizations, denials and appeals, payment posting, and accounts receivable follow-up.
- Proficiency with electronic health records, billing systems, payer portals, and Microsoft Excel.
- Strong attention to detail, independent problem-solving, organization, and professional communication skills.
Preferred Qualifications
- Experience in pediatric or integrated behavioral health settings.
- Experience with Office Practicum, TRICARE, collaborative care billing, payer audits, or staff training.
- Associate degree or additional coursework in medical billing, coding, health information, or a related field.
Location
Jacksonville, Florida, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
2 weeks ago
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