Behavioral Health Billing Specialist

We are seeking a highly organized, detail-oriented Behavioral Health Billing Specialist to join our growing team. This position is responsible for managing outpatient billing operations, insurance verification, authorization tracking, payment reconciliation, and claims management for behavioral health treatment services.

The ideal candidate will have experience working with Medicaid, Managed Care Organizations (MCOs), Fee-for-Service (FFS) funding, private insurance billing, and behavioral health electronic medical records such as KIPU. Strong attention to detail, accuracy, and the ability to work independently are essential for success in this role.

Key Responsibilities
Insurance Verification & Eligibility
Verify insurance eligibility and benefits through EMEVS and other payer portals.
Run EMEVS eligibility checks for potential outpatient admissions and communicate funding information to admissions staff.
Complete eligibility verification for newly admitted outpatient clients and update insurance information within KIPU as needed.
Conduct monthly eligibility reviews for all active outpatient clients and notify appropriate staff of funding changes.
Billing & Claims Management
Bill Medicaid, Fee-for-Service (FFS), and other applicable outpatient claims accurately and timely.
Assist with back billing and claim correction projects as needed.
Reconcile outpatient Medicaid and FFS payments and investigate billing discrepancies.
Submit and track claims to ensure maximum reimbursement.
Process and send deductible and co-payment invoices to clients.
Authorization Management
Track and maintain outpatient authorizations.
Monitor authorization expiration dates and notify counselors of upcoming renewals.
Add Vivitrol services to applicable Fee-for-Service authorizations.
Ensure services are properly authorized prior to billing.
Data Reconciliation & Reporting
Reconcile bed utilization charts with billing spreadsheets to ensure data accuracy.
Update outpatient billing spreadsheets on a weekly basis using attendance records and service documentation.
Post Medicaid remittance payments and maintain accurate reimbursement tracking spreadsheets.
Maintain organized billing records and documentation for audits and compliance purposes.
Payment Reconciliation
Reconcile Medicaid, FFS, and other payer payments.
Review remittance advice and resolve payment discrepancies.
Track outstanding claims and follow up on denied or unpaid claims.
Additional Responsibilities
Process and track state Uber transportation reimbursement requests.
Provide billing support and coverage for Detox and Residential billing operations when needed.
Assist with special billing projects and departmental initiatives.
Collaborate with admissions, clinical, and finance teams to ensure accurate and timely billing processes.
Qualifications
Required
Minimum 2 years of healthcare or behavioral health billing experience.
Knowledge of Medicaid, Managed Care Organizations (MCOs), Fee-for-Service (FFS), and private insurance billing.
Experience with insurance eligibility verification and authorization management.
Strong Microsoft Excel and spreadsheet management skills.
Excellent organizational and time management abilities.
Strong attention to detail and accuracy.
Preferred
Experience with KIPU EMR.
Experience with behavioral health, substance abuse, or mental health treatment programs.
Knowledge of EMEVS eligibility verification systems.
Experience with claim reconciliation, remittance posting, and denial management.
Skills & Competencies
Strong analytical and problem-solving skills.
Ability to manage multiple priorities in a fast-paced environment.
Excellent communication and collaboration skills.
Ability to work independently with minimal supervision.
High level of confidentiality and professionalism.
Strong understanding of healthcare billing regulations and compliance requirements.
Schedule
Full-Time
Monday through Friday
Standard business hours
Compensation

Compensation is based on experience and qualifications.