Billing Specialist

Job Description

Job Description

Description:

Ability Plus Mental Health Clinic is seeking a compassionate and experienced Behavioral Health Billing specialist to support the financial operations of Ability Plus. The Billing specialist is responsible for overseeing, tracking, billing processes, and insurance operations in the clinic. This role ensures accurate revenue cycle management, compliance with Medicaid and commercial insurance requirements, and supports the clinic’s financial health through reporting, auditing, and process improvement. The position plays a critical role in maintaining revenue integrity, compliance, and audit readiness.

Requirements:

• Lead end-to-end Revenue Cycle engagements for a Mental health providers, with deep expertise across Patient Access (scheduling, registration, eligibility, prior authorization), Mid-Cycle/Revenue Integrity (CDM, charge capture, CDI, coding), and Back-End Operations (billing, collections, denials management, underpayment recovery and overpayment returns).
• Manage daily provider billing operations, including charge processing, claim submission, payment posting, A/R follow-up, denials, and account resolution.
• Supervise, train, coach, and evaluate providers and billing staff; monitor productivity, quality, and workload.
• Monitor key performance indicators, including days in A/R, aging, denial rates, clean claim rates, charge lag, collections, and staff productivity.
• Analyze denial and reimbursement trends and coordinate corrective actions with coding, registration, authorization, clinical departments, and payers.
• Research and resolve complex Medicare, Medicaid, Medicare Advantage, and commercial payer billing issues.
• Ensure billing activities comply with CMS, payer, HIPAA, and organizational requirements.
• Assist with development and maintenance of billing policies, procedures, workflows, claim edits, and departmental controls.
• Support revenue cycle system configuration, testing, upgrades, and implementation of new providers, clinics, and services.
• Collaborate with providers, practice leadership, finance, Coding, IT, Compliance, and other departments to improve revenue cycle performance.
• Assist the practice manager with reporting, budgeting, staffing, audits, strategic initiatives, and special projects.
• Serve as departmental leader and decision-maker in the billing department.
• Remain up to date with MMA and private insurance changes
• Ensure compliance with payer requirements
• Remain up to date with MMA and private insurance changes
• Ensure compliance with payer requirements

Systems & Reporting

• Utilize Athena EHR and practice management systems to manage billing workflows.
• Leverage dashboards, reports, and trend analysis to drive accountability and results.

Qualifications and Skills:

• Experience in medical billing and revenue cycle management.
• Proven experience leading billing turnaround initiatives for specialty practices.
• Excellent leadership, coaching, and stakeholder communication skills.
• Highly data-driven with strong analytical capabilities.
• Proficiency with Athena or similar EHR/practice management systems preferred