Senior Billing Specialist Behavioral Health

Senior Billing Specialist Behavioral Health Nimel Mental Health Berwyn Heights, MD Job Details Full-time $55,788.09 - $65,959.84 a year 15 hours ago Benefits Paid time off Qualifications Revenue cycle management Appeals Medical coding compliance oversight Medical collection Insurance prior authorization Medicare Electronic health records (EHR) management Achieving HIPAA compliance 5 years Insurance claim appeals processing Regulatory compliance in claims processing Compliance audits & assessments HIPAA Patient advocacy Outpatient Financial performance report preparation Financial analysis Analysis skills Policy & process development Centers for Medicare and Medicaid Services (CMS) Mentoring Clinical documentation Medical insurance appeals management Healthcare policy development Financial management Senior level Training Escalation handling Excel data analysis Full Job Description Job Summary We are seeking a highly motivated and detail-oriented Senior Billing Specialist with expertise in Behavioral Health to join our dynamic team. In this pivotal role, you will serve as subject matter expert in revenue cycle management, with 5+ years of experience focusing on complex reimbursement scenarios, including Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), PRP(Psychiatric Rehabilitation Program), TMS, and specialized mental health services. Responsible for driving financial performance, managing audit risks, and mentoring junior staff. Your deep understanding of medical coding, billing procedures, and electronic health record (EHR) systems will drive efficiency and compliance across all billing operations. This position offers an exciting opportunity to contribute to a compassionate healthcare environment while honing your skills in medical coding, claims management, and revenue cycle optimization.

Duties Core Job Duties and Responsibilities Advanced Claims Management:

Prepare and submit complex claims (CMS-1500 and UB-04) for PHP, IOP, and outpatient services. Review and process medical claims related to behavioral health services using CPT (Current Procedural Terminology), ICD-9, ICD-10, and DRG (Diagnosis-Related Group) coding standards to ensure accuracy and compliance. Collaborate with clinicians and administrative staff to verify medical records, documentation, and coding details for billing purposes Submit claims daily to insurance payers, follow up on unpaid or denied claims, and perform appeals as necessary to maximize reimbursement. Conduct thorough medical collections activities by contacting insurance companies and patients to resolve outstanding balances.

Denial Management & Appeals:

Investigate, appeal, and resolve complex claim denials, EOB discrepancies, and underpayments.

Revenue Cycle Optimization:

Monitor accounts receivable (A/R) aging reports to reduce aged AR over 60/90 days.

Compliance & Auditing:

Audit clinical documentation to ensure it supports the billed level of care and compliance with HIPAA and payer regulations.

Payer Relations:

Act as the primary contact for insurance companies regarding contract rates, authorization discrepancies, and reimbursement issues.

EHR Management:

Serve as a subject matter expert in the Electronic Health Record (EHR) system (e.g., Credible, Epic, Cerner) for billing setup, code maintenance, and troubleshooting.

Reporting:

Analyze billing data to provide daily/weekly/monthly financial reports, productivity, and revenue projections to management. This is mandatory Specialty Services Billing (PHP/IOP)

Per-Diem Billing:

Master the distinction between Medicare/Medicaid per-diem (flat daily rate) payments and commercial fee-for-service (individual code) requirements.

Authorization Management:

Obtain and track authorizations, ensuring the authorized service dates and units match the clinical documentation and billed hours (e.g., 20+ hours/week for

PHP, 9-19

hours/week for IOP).

Revenue Coding:

Utilize correct revenue codes (e.g., 0905 for

IOP, 0912/0913

for PHP) and

ICD-10-CM

codes for behavioral health.

Bundling & Modifiers:

Implement proper coding protocols for bundling multiple services (group therapy, individual therapy, medication management) into a single daily claim.

Condition Codes:

Apply specific codes, such as Condition Code 92 for IOP and Condition Code 41 for PHP, to identify specialized outpatient services.

Leadership and Administrative Duties Mentorship:

Train and mentor junior billing staff on behavioral health billing, coding, and system usage.

Credentialing Support:

Coordinate credentialing to ensure clinicians are active on insurance panels.

Policy Development:

Contribute to developing billing policies and procedures for improving revenue cycle efficiency.

Patient Advocacy:

Handle escalated patient billing calls, explaining coverage issues, and managing payment plans.

Qualifications and Key Skills Proven Experience:

5+ years in medical billing, specifically within a behavioral health, substance abuse (SUD), mental health or psychiatric facility setting.

Systems Expertise:

Proficiency in EHR systems such as Credible, Epic, or ICanote and billing clearinghouses.

Coding Knowledge:

Strong understanding of CPT, HCPCS, and

ICD-10-CM

coding, especially for psychiatric services.

Analytical Skills:

Ability to analyze large datasets in Excel to identify trends in denials or revenue opportunities

Job Type:

Full-time Pay:

$55,788.09 - $65,959.84 per year

Benefits:

Paid time off

Work Location:

In person