Medical Biller

Position Summary:

The Medical Biller is responsible for managing all aspects of the billing process for mental health and psychiatric services. This role ensures accurate claim submission, timely reimbursement, and compliance with payer, regulatory, and organizational standards. The ideal candidate has experience in behavioral health billing, including knowledge of psychiatric services, insurance requirements, and revenue cycle management.

Key Responsibilities:

• Prepare, review, and submit electronic and paper claims for mental health and psychiatric services.
• Verify patient insurance eligibility and benefits prior to claim submission.
• Ensure accurate coding (CPT, ICD-10, HCPCS) specific to behavioral health services.
• Follow up on unpaid, denied, or rejected claims and resolve billing issues promptly.
• Communicate with insurance companies regarding claim status, authorizations, and appeals.
• Post payments, adjustments, and reconcile accounts receivable.
• Maintain compliance with federal, state, and payer-specific regulations.
• Collaborate with clinical staff to ensure proper documentation supports billed services.
• Identify trends in denials and recommend process improvements.
• Maintain confidentiality in accordance with HIPAA guidelines.

Required Qualifications:

• High school diploma or equivalent (Associate’s or Bachelor’s degree preferred).
• Minimum of 2–3 years of medical billing experience, preferably in mental health or psychiatry.
• Knowledge of behavioral health billing codes and payer requirements.
• Experience with electronic medical records (EMR) and billing systems.
• Strong understanding of insurance processes, including Medicare, Medicaid, and commercial payers.

Preferred Qualifications:

• Certification such as Certified Professional Biller (CPB) or Certified Coding Specialist (CCS).
• Experience with behavioral health EMR systems (e.g., InSync).
• Familiarity with prior authorizations and utilization review processes.

Core Competencies:

Knowledge of Behavioral Health Billing:

• Demonstrates expertise in billing for mental health and psychiatric services.
• Understands payer-specific requirements and documentation standards.

Attention to Detail:

• Ensures accuracy in coding, billing, and data entry.
• Identifies and corrects errors proactively.

Analytical and Problem-Solving Skills:

• Analyzes claim denials and determines appropriate resolution strategies.
• Identifies trends and contributes to process improvements.

Communication Skills:

• Effectively communicates with insurance representatives, patients, and internal staff.
• Provides clear and professional documentation of billing activities.

Compliance and Integrity:

• Adheres to HIPAA, regulatory requirements, and organizational policies.
• Maintains confidentiality and ethical standards in all billing practices.