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.

• 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