Medical Billing and Coding Specialist Simple Serene Detox & Recovery Mesa, AZ Job Details Part-time | Full-time From $30 an hour 10 hours ago Qualifications Appeals Overseeing health insurance pre-certification Accounts receivable management Payment processing HIPAA High school diploma or GED Case appeal in utilization management Electronic health record (EHR) management for billing and coding Medical billing and coding communication with insurance companies Computer skills Medical claims submission Medical Billing Certification Insurance claims appeal handling Medical terminology Documentation review Full Job Description Medical Billing & Coding Specialist -

Detox & Behavioral Health Facility:

Simple & Serene Detox & Recovery Location:

Mesa, Arizona Employment Type:

Full-Time Work Location:

On-Site -

Mesa, AZ Department:

Billing & Revenue Cycle Reports To:

Administrator / Operations Director Position Summary Simple & Serene Detox & Recovery is seeking an experienced Medical Billing & Coding Specialist with a strong background in behavioral health, substance use disorder treatment, detoxification, or residential treatment billing . This is an on-site position responsible for supporting the facility's complete revenue-cycle process, including insurance verification, authorizations, coding, claim submission, payment posting, denial management, accounts receivable follow-up, and reconciliation. The ideal candidate understands that successful behavioral-health billing requires more than submitting claims. This individual must proactively identify authorization, documentation, coding, credentialing, and payer issues before they result in lost revenue. Essential Duties & ResponsibilitiesMedical Billing & Claims Management Prepare and submit accurate insurance claims for detoxification and behavioral health services. Review claims for accuracy and completeness prior to submission. Ensure claims are submitted to the appropriate payer within required filing deadlines. Monitor electronic claim acceptance and rejection reports. Correct and resubmit rejected claims promptly. Track claims from initial submission through final payment. Submit corrected claims, reconsiderations, and appeals when necessary. Maintain accurate documentation of all billing activity. Identify billing trends that may negatively affect reimbursement. Behavioral Health & Detox Billing Maintain working knowledge of billing requirements applicable to detoxification, withdrawal management, substance use disorder, residential, and behavioral health services. Understand payer-specific requirements related to levels of care, authorization, medical necessity, and reimbursement. Review clinical documentation to determine whether required documentation is present to support billed services. Work collaboratively with clinical, nursing, medical, utilization review, and admissions personnel to resolve documentation deficiencies. Communicate recurring documentation issues to leadership. Maintain knowledge of applicable CPT, HCPCS, ICD-10-CM, revenue codes, modifiers, and other coding requirements relevant to assigned services. Insurance Verification & Benefits Verify insurance eligibility and benefits prior to or immediately following admission as appropriate. Confirm behavioral health and substance use disorder benefits. Determine deductibles, copayments, coinsurance, out-of-pocket requirements, and other available benefit information. Identify network status and payer requirements. Document verification results accurately. Communicate relevant financial information to admissions and leadership. Reverify benefits when clinically or operationally necessary. Authorization & Utilization Review Support Coordinate closely with admissions and utilization review personnel regarding initial and continued-stay authorization requirements. Track authorization numbers, approved dates, levels of care, and authorized units/days. Maintain authorization tracking systems. Identify authorization expirations before they create billing problems. Assist with submission of required payer information when assigned. Immediately escalate authorization discrepancies or potential coverage issues. Reconcile authorized services against billed services. Coding & Documentation Review Review medical and behavioral health documentation for coding and billing completeness. Assign or validate applicable diagnosis and procedure codes consistent with qualifications and assigned responsibilities. Identify missing, inconsistent, incomplete, or potentially noncompliant documentation. Work with authorized clinical and medical personnel to obtain legitimate documentation corrections when necessary. Never alter clinical documentation or direct clinicians to document services that were not actually provided. Maintain coding practices consistent with applicable payer and regulatory requirements. Claims Follow-Up & Accounts Receivable Maintain active oversight of outstanding accounts receivable. Follow up consistently on unpaid and underpaid claims. Contact insurance companies regarding claim status and reimbursement issues. Research aged accounts and identify barriers to payment. Work denials promptly. Track payer correspondence and requests for additional information. Escalate significant or recurring reimbursement problems to leadership. Maintain organized aging reports. Prioritize high-dollar and time-sensitive accounts. Denials & Appeals Review and categorize claim denials. Determine appropriate corrective action. Correct billing errors and resubmit claims when appropriate. Prepare reconsideration and appeal documentation. Coordinate with medical and clinical staff when additional supporting documentation is legitimately required. Track appeal deadlines and outcomes. Analyze denial patterns and recommend corrective action. Help reduce preventable denials through front-end process improvement. Payment Posting & Reconciliation Post insurance payments, adjustments, and patient responsibility accurately. Review electronic remittance advice and explanation-of-benefit documentation. Identify underpayments and incorrect contractual adjustments. Reconcile payments against submitted claims. Identify discrepancies between expected and actual reimbursement. Coordinate with accounting and leadership regarding deposits and reconciliation. Maintain accurate patient-account balances. Credentialing & Payer Support Assist leadership and credentialing personnel with payer-related administrative issues as assigned. Maintain current payer contact information and billing requirements. Help identify credentialing or enrollment issues affecting claims. Track payer changes that may impact reimbursement. Assist with payer portals and electronic billing systems. Revenue Cycle Reporting Provide leadership with regular reporting regarding: Claims submitted Payments received Outstanding accounts receivable Aging by payer Denial rates Rejection rates Underpayments Authorization issues Unbilled accounts Billing holds Appeal status Major payer issues Revenue-cycle trends The Billing Specialist should be able to clearly explain where the facility's money is, what is preventing payment, and what action is being taken to collect it. Compliance & Confidentiality Maintain compliance with HIPAA and applicable substance use disorder confidentiality requirements. Protect confidential client, financial, and insurance information. Follow applicable federal and state billing requirements. Maintain ethical coding and billing practices. Never knowingly submit claims for services that were not provided or supported by documentation. Report suspected billing, documentation, or compliance concerns to leadership. Participate in internal billing audits and corrective-action initiatives. Maintain records necessary to support payer audits and reviews. Required Qualifications High school diploma or GED required. Minimum 2 years of medical billing experience strongly preferred. Previous experience with healthcare insurance claims and revenue-cycle processes. Working knowledge of ICD-10-CM, CPT, HCPCS, and healthcare billing terminology. Experience with insurance verification, claim submission, denials, appeals, payment posting, and accounts receivable. Strong computer and electronic medical record skills. Excellent attention to detail. Strong organizational and problem-solving abilities. Ability to manage multiple payer accounts and deadlines. Strong written and verbal communication skills. Ability to maintain confidential information. Ability to work on-site at our Mesa, Arizona facility. Strongly Preferred Qualifications Behavioral health billing experience. Substance use disorder treatment billing experience. Detoxification or withdrawal-management billing experience. Residential treatment billing experience. Experience billing commercial insurance and/or Arizona Medicaid/AHCCCS programs. Experience with behavioral health authorizations and utilization review. Experience working with behavioral health EMRs and clearinghouses. Experience managing behavioral health denials and appeals. Certified Professional Coder ( CPC ), Certified Coding Specialist ( CCS ), Certified Professional Biller ( CPB ), or comparable coding/billing certification. Knowledge, Skills & Abilities The successful candidate should have a strong understanding of healthcare revenue-cycle management and be able to work independently without waiting for leadership to discover billing problems. The individual must be analytical, persistent, organized, deadline-driven, comfortable communicating with insurance companies, and capable of collaborating professionally with admissions, clinical, nursing, medical, and administrative personnel. Behavioral-health billing experience is highly valued because the position requires understanding the relationship between admission, eligibility, authorization, medical necessity, documentation, coding, claim submission, and reimbursement. Schedule Full-Time | On-Site Monday-Friday | Day Shift This is not a remote position . The Medical Billing & Coding Specialist will work from the Simple & Serene Detox & Recovery facility in Mesa, Arizona and collaborate directly with admissions, clinical, nursing, utilization review, and administrative leadership. Performance Expectations Success in this position will include timely clean-claim submission, aggressive but appropriate AR follow-up, accurate coding, reduced preventable denials, timely appeals, accurate payment posting, identification of underpayments, strong authorization tracking, low unbilled-account volume, accurate reporting, and consistent communication with leadership regarding revenue-cycle risks. Our Mission At Simple & Serene Detox & Recovery , our mission is to provide a safe, compassionate, and peaceful environment where individuals can stabilize, heal, and begin building a foundation for lasting recovery. Strong clinical care requires strong operations. Our Medical Billing & Coding Specialist plays a critical role in protecting the financial health of the organization so our team can continue providing high-quality treatment to individuals and families affected by addiction. Simple & Serene Detox & Recovery is an Equal Opportunity Employer.

Pay:

From $30.00 per hour

Work Location:

In person