Independent Contractor - Outpatient Adult Mental Health Billing Claims Specialist

Job Responsibilities:

Perform full-cycle billing functions for mental and behavioral health services, managing complex claims with a high level of accuracy and efficiency. Manage the daily submission of high-volume primary and secondary claims, ensuring compliance with payer requirements. Verify and validate all claim data, including provider information, member eligibility, filing limits, and coding for HCPCS, CPT, diagnoses, and procedures. Effectively validate claim acceptance to ensure successful submission and timely reimbursement. Apply in-depth knowledge of payer requirements, including MassHealth/Medicaid, commercial insurers, and coordination of benefits (COB). Proactively manage denied and rejected claims by researching, reviewing, correcting, and appealing complex or escalated issues to ensure timely resolution. Prevent recurring errors and maintain clear communication with insurance companies and families throughout the resolution process. Utilize billing systems, including EDI, clearinghouses, CMS-1500/UB forms, and EHR platforms, to ensure accurate claim submission and tracking. Monitor billing workflows for problems, such as claims not processing correctly or a high volume of outstanding accounts receivable and take appropriate corrective action. Generate client statements, conduct collection follow-ups, and process invoices as needed to maintain clean accounts receivable balances. Collaborate with internal teams to resolve billing discrepancies and improve claim accuracy at the source, supporting workflow efficiency and process improvement initiatives. Support other billing and revenue cycle tasks as assigned, contributing to overall organizational financial performance. Previous experience with DWIHN or PCE based system is preferred.

Competencies:

Strong attention to detail, with the ability to accurately review and resolve complex billing discrepancies. Advanced problem-solving and analytical skills, particularly in resolving denials, rejections, and accounts receivable issues. Excellent organizational and time-management skills in a fast-paced, high-volume environment. Effective verbal and written communication, with the ability to collaborate with internal teams, payers, and families. Ability to work independently, taking ownership of tasks and following through to completion. Strong prioritization and multitasking abilities while managing concurrent deadlines and processing a high volume of claims efficiently. Proficiency in Excel and billing/reporting systems, with the ability to analyze data and support process improvements. In-depth knowledge of MassHealth, behavioral health billing, and revenue cycle processes, ensuring compliance and accurate reimbursement. Experience with Qualifacts Carelogic and Inovalon clearinghouse systems preferred, with the ability to apply system functionality for accurate claims management and reporting

Minimum Requirements:

Associate's or bachelor's degree in healthcare administration, finance, business, or related field (or equivalent experience). 4+ years of experience in medical billing or revenue cycle management, including third-party billing, preferably in behavioral or mental health. Strong knowledge of payer requirements (MassHealth/Medicaid, commercial insurers, COB) and claims lifecycle management (submissions, denials, appeals, reimbursement). Both part time and full time opportunities are available. Pulse Community Health is an equal opportunity employer and is committed to creating an inclusive, welcoming place for everyone.

Pay:

$17.00 - $25.00 per hour Expected hours: 15.0 - 20.0 per week

Work Location:

Hybrid remote in Rochester Hills, MI 48309