Billing Specialist

Billing Specialist

The Billing Specialist will be responsible for managing all billing functions for the agency's Outpatient Mental Health Clinic (OMHC) and Medication Management programs. This includes claim creation, submission, payment posting, corrections, denials management, and ensuring compliance with state and federal regulations. The contractor will work independently to maintain accurate billing records, ensure timely reimbursement, and support leadership with billing-related reporting.

Key Responsibilities

• Prepare and submit clean claims for OMHC and Medication Management services to Medicaid, Medicare, and commercial insurance payers.
• Verify client insurance coverage and eligibility as needed.
• Update all billing tracking documentation in real time.
• Review documentation and ensure all services meet billing and compliance standards before claim submission.
• Monitor accounts receivable and follow up on unpaid, underpaid, or denied claims.
• Resolve billing issues, complete corrections, and resubmit denied claims.
• Post payments, adjustments, and reconcile accounts for accuracy.
• Maintain accurate, organized billing records and reports.
• Communicate with clinical and administrative staff to clarify coding or documentation questions.
• Ensure compliance with HIPAA, payer regulations, and behavioral health billing requirements.
• Provide weekly billing summaries and financial reports to agency leadership.
• Keep up-to-date with payer policy changes related to behavioral health, OMHC, and medication management services.

Qualifications

• Proven experience in behavioral health billing, preferably with OMHC and Medication Management programs.
• Strong understanding of CPT codes, behavioral health service codes, and Medicaid requirements.
• Experience with claim submission platforms, clearinghouses, and EMR systems.
• Knowledge of HIPAA compliance and billing regulations.
• Excellent attention to detail and accuracy.
• Ability to work independently and meet deadlines.
• Strong communication and problem-solving skills.

Position Details

• This is an Hourly position.
• Contractor must provide their own equipment and workspace.
• Compensation is based on experience or per-claim/per-project structure as agreed upon.
• Flexible working hours; must meet agency deadlines and billing cycles.