Benefits:

401(k)

Dental insurance

Health insurance

Paid time off

Vision insurance

Job Summary:

We are seeking a detail-oriented and experienced Medical Billing Specialist to join our team, specializing in Substance use disorder and behavioral health billing. The ideal candidate will have extensive knowledge of Medicaid and commercial insurance billing requirements and processes, with a strong understanding of multiple levels of care, including residential, partial hospitalization programs (PHP), intensive outpatient programs (IOP), and outpatient programs. This position requires accuracy, efficiency, and a commitment to ensuring timely and compliant reimbursement for services rendered.

Key Responsibilities:

Prepare and submit claims to Medicaid and commercial insurance providers for behavioral health services across multiple levels of care (e.g., inpatient, outpatient, IOP, PHP, and residential).

Ensure accurate and complete coding of claims based on industry standards.

Monitor and track submitted claims to ensure timely reimbursement and minimize denials.

Investigate and resolve claim denials and discrepancies by coordinating with payers and internal staff.

Perform payment posting and reconciliation to ensure all payments are accurately recorded.

Maintain a thorough understanding of Medicaid and commercial payer policies and stay updated on changes and requirements.

Work closely with clinical and administrative staff to ensure accurate patient and insurance information.

Conduct regular audits to identify billing issues and implement corrective actions.

Respond to patient and payer inquiries regarding billing issues and account status.

Ensure compliance with HIPAA and other regulatory requirements.

Other duties as assigned

Qualifications:

High school diploma or GED required; associate's or bachelor's degree in healthcare administration, business, or related field preferred.

2+ years of experience in medical billing, with a focus on behavioral health.

Strong knowledge of Medicaid and commercial insurance billing requirements and guidelines.

Familiarity with multiple levels of care, including residential PHP, IOP, and outpatient.

Proficiency with medical billing software.

Strong understanding of medical coding.

Ability to research and resolve complex billing issues and payer denials.

Excellent attention to detail, analytical skills, and problem-solving ability.

Strong communication skills and the ability to work effectively with both internal and external stakeholders.

Knowledge of HIPAA compliance and confidentiality standards