SENIOR BEHAVIORAL HEALTH BILLING SPECIALIST

SENIOR BEHAVIORAL HEALTH BILLING SPECIALIST

POSITION SUMMARY:

The agency is a behavioral health organization providing mental health, substance-use disorder, addiction treatment, psychiatric rehabilitation, peer recovery, and related supportive services. We seek an experienced Senior Behavioral Health Billing Specialist to lead the complete billing and collection lifecycle. The position independently manages complex billing matters; verifies eligibility and authorizations; reviews documentation for billing readiness; submits accurate claims; posts and reconciles payments; resolves denials and appeals; monitors accounts receivable; supports provider enrollment; produces revenue reports; reviews the work of billing personnel; and strengthens billing controls, collections, and regulatory compliance. Advanced knowledge of Maryland Medicaid, managed-care organizations, behavioral-health reimbursement, payer requirements, and revenue-cycle operations is required.

PROGRAMS INCLUDE:

5.Psychiatric Rehabilitation Program—PRP Adults 6.Psychiatric Rehabilitation Program—PRP Minors

DUTIES AND RESPONSIBILITIES

1.REVENUE-CYCLE LEADERSHIP AND OVERSIGHT

Coordinate the complete revenue cycle from intake and eligibility verification through final payment, appeal, adjustment, or approved write-off. Maintain billing workflows, standard operating procedures, calendars, checklists, internal controls, and timely-filing safeguards. Identify causes of delayed billing, rejections, denials, underpayments, aged receivables, or lost revenue; implement corrective actions to improve clean-claim acceptance, collections, cash flow, and compliance. Coordinate priorities with executive management, finance, accounting, compliance, clinical leadership, intake, and program operations, and report material payer issues, denials, revenue-cycle performance, and compliance risks.

2.CLAIMS REVIEW, PREPARATION, AND PROGRAM BILLING

Review services for billing readiness and confirm complete, compliant documentation. Validate client and payer data, provider credentials, dates of service, authorizations, units, diagnosis and service codes, modifiers, place of service, NPI, taxonomy, and other required claim elements. Prepare, review, and submit clean electronic or paper claims using applicable CPT, HCPCS, ICD-10-CM, revenue-code, modifier, unit, professional, and institutional claim requirements. Review clearinghouse edits and payer acknowledgements; promptly correct and resubmit rejected, replacement, voided, or previously denied claims. Oversee billing for OMHC assessments and therapy, psychiatric evaluation and medication management, IOP, outpatient SUD, Peer Recovery Services, PRP Adult, PRP Minor, and other approved reimbursable services. Distinguish billable clinical services from non-billable support, bundled, grant-funded, unauthorized, undocumented, or non-covered activities. 3.ELIGIBILITY, AUTHORIZATION, AND DOCUMENTATION CONTROLS Verify Maryland Medicaid, Medicare, managed-care, and commercial coverage before or immediately upon admission and throughout service participation. Confirm member information, effective dates, coordination of benefits, covered services, copayments, deductibles, limitations, and discrepancies. Manage initial authorizations, concurrent reviews, extensions, reauthorizations, and level-of-care changes. Track authorization numbers, dates, approved units, frequency, provider and location; compare authorized, scheduled, and delivered services; and elevate expiring or insufficient authorizations before reimbursement is affected. Review records for required dates, signatures, credentials, service times, locations, treatment-plan relationships, codes, units, and payer elements. Maintain billing holds, communicate deficiencies, monitor corrections, train affected staff, and never alter records or direct documentation of services not provided.

PAYMENT POSTING, DENIALS, AND ACCOUNTS RECEIVABLE

Oversee posting and reconciliation of ERA/EOB payments, EFTs, client payments, adjustments, recoupments, refunds, denials, credit balances, and unapplied funds. Identify underpayments, overpayments, duplicate payments, takebacks, incorrect adjustments, and variances; coordinate resolution with payers, finance, accounting, and management. Lead denial management by identifying root causes, preparing corrected claims, reconsiderations, appeals, medical-necessity responses, and supporting records within payer deadlines. Maintain a denial log capturing payer, client ID, program, date of service, amount, denial code and reason, corrective action, deadline, follow-up, and final disposition. Monitor receivables by payer, program, provider, client, claim status, and aging categories of 0–30, 31–60, 61–90, 91–120, and over 120 days. Prioritize high-dollar and timely-filing-sensitive balances, document payer contacts, develop aged-AR action plans, and recommend write-offs only after reasonable collection and appeal efforts and required approval.

REVENUE RECONCILIATION AND SERVICE-LINE REPORTING

Reconcile documented and authorized services to claims submitted, claims accepted, payments, denials, adjustments, and outstanding balances. Identify delivered services not billed and claims lacking complete support; reconcile billed and collected revenue by program. Produce accurate reports by service line, client ID, payer, provider, CPT/HCPCS code, date of service, amount billed, allowed and paid, adjustment, denial, and collection status. Support month-end reconciliation, monthly/quarterly/annual reporting, payer performance, collection-rate analysis, revenue per client, and service-line profitability reporting. BILLING TEAM LEADERSHIP, PAYER RELATIONS, AND CREDENTIALING Provide technical guidance, quality review, coaching, onboarding, and training to billing, authorization, and assigned staff. Coordinate work queues and deadlines; conduct claim and file audits; monitor productivity and accuracy; and serve as acting billing lead when designated, without formal personnel authority unless separately delegated. Serve as a senior payer contact; interpret policies, manuals, bulletins, fee schedules, portal notices, billing instructions, and utilization requirements; document guidance; elevate unresolved claims, authorization, credentialing, or reimbursement issues; and communicate material changes to agency personnel. Confirm that rendering, billing, supervising, and ordering providers are properly licensed, enrolled, credentialed, linked, and active. Maintain NPI, taxonomy, license, service-location, enrollment, revalidation, participation, and organizational affiliation information, and prevent claims under inactive, expired, inaccurate, or unauthorized provider data. AUDITS, POLICIES, PRIVACY, AND REGULATORY COMPLIANCE Prepare records for internal, payer, government, utilization, payment-integrity, and compliance reviews. Conduct periodic billing audits; identify unsupported, duplicated, improperly coded, unauthorized, or incorrectly paid claims; report and resolve potential overpayments; maintain audit records. Develop and maintain procedures and controls for eligibility, authorizations, documentation review, charge entry, claims, payment posting, denials, appeals, AR follow-up, refunds, credit balances, adjustments, write-offs, month-end reconciliation, record retention, access, segregation of duties, and prevention of duplicate or unsupported claims. Comply with HIPAA, applicable Maryland requirements, payer contracts, agency policies, fraud-waste-and-abuse standards, and 42 CFR Part 2 where relevant.

REQUIRED QUALIFICATIONS

Associate or bachelor’s degree in health information management, healthcare administration, finance, accounting, business administration, or a related discipline. Certified Professional Biller—CPB. Certified Professional Coder—CPC. Certified Coding Specialist—CCS. Certified Billing and Coding Specialist—CBCS. Certified Revenue Cycle Representative—CRCR. Certified Revenue Cycle Professional—CRCP. A comparable nationally recognized billing, coding, compliance, finance, or revenue-cycle certification may be accepted. Seven or more years of healthcare billing or revenue-cycle experience and five or more years of behavioral-health billing experience. Prior experience as a senior biller, billing lead, revenue-cycle lead, billing supervisor, or comparable subject-matter expert. Experience billing OMHC, IOP, outpatient SUD, Peer Recovery Services, PRP Adult, PRP Minor, medication-management, or comparable behavioral-health services. Experience with Carelon Behavioral Health or comparable behavioral-health managed-care systems. Experience with Maryland Medicaid systems, payer portals, electronic eligibility tools, and behavioral-health EHR, practice-management, clearinghouse, accounting, or claims-management systems. Knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NPI, taxonomy, ANSI 837 claim transactions, and 835 remittance transactions. Experience with denials, reconsiderations, appeals, accounts receivable, payer audits, medical-record reviews, payment-integrity reviews, recoupments, overpayments, and corrective-action plans. Experience developing billing procedures, internal controls, staff training, quality reviews, and key performance indicators.

ON-SITE WORK REQUIREMENTS

Work full-time at the designated agency facility in Baltimore County, Maryland, Monday–Friday.

COMPENSATION:

$75,000.00 - $85,000.00/yr.

BENEFITS:

Health insurance Dental insurance Vision insurance Paid time off Paid holidays Retirement plan Life insurance Professional-development assistance #J-18808-Ljbffr Tettragon