Behavioral Health Billing & Utilization Specialist

Turning Point Behavioral Health; Madison (SD); On-site; USD 42,000 - 64,000; Full time

Job summary

Turning Point Behavioral Health is seeking a Medical Billing / Utilization Review Specialist to oversee billing, authorization management, and utilization reviews for residential behavioral health and substance use disorder services in South Dakota.

You will verify insurance, submit claims, monitor the revenue cycle, and coordinate with admissions, clinical, and leadership teams to ensure compliant documentation and timely reimbursement.

Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• 5+ years of experience in residential treatment billing or revenue cycle management preferred.
• Knowledge of Medicaid/Medicare and payer requirements for residential treatment preferred.
• Experience with CPT, HCPCS, ICD-10 coding, UB-04 and CMS-1500 claim forms and electronic billing systems preferred.

Responsibilities

• Review and process billing for residential behavioral health and SUD treatment services.
• Verify insurance eligibility, benefits, authorizations, and payer requirements prior to and throughout treatment episodes.
• Submit clean claims and monitor claims through the full revenue cycle process to support timely reimbursement.
• Manage utilization review functions, including initial authorizations, concurrent reviews, continued stay requests, peer review coordination, and payer communication.
• Collaborate with clinical staff to ensure documentation supports medical necessity, level of care, and continued stay criteria.
• Track authorization periods, payer deadlines, denials, underpayments, and appeal opportunities.
• Maintain accurate client account records, billing data, and insurance information in organizational systems.
• Assist with reimbursement follow-up and collections involving Medicaid, Medicare, and commercial payers.
• Identify trends related to denied, delayed, or underpaid claims and communicate areas needing corrective action.
• Ensure compliance with payer guidelines, organizational standards, and all applicable state and federal regulations.
• Support operational improvement in billing, utilization review, and reimbursement workflows, particularly for South Dakota-based services.
• Communicate effectively with insurance representatives, internal staff, and leadership regarding authorization and billing issues.
• Help ensure continuity of operations by reducing avoidable disruptions in reimbursement and authorization processes.

Skills

Billing knowledge

Utilization review

Attention to detail

Team collaboration

Communication skills

Education

High school diploma or equivalent

Associate's or Bachelor's degree in healthcare admin or related field preferred

Tools

CPT

HCPCS

ICD-10 coding

UB-04 / CMS-1500 forms

Electronic billing systems

Job description

Turning Point Behavioral Health is seeking a Medical Billing / Utilization Review Specialist to oversee billing, authorization management, and utilization reviews for residential behavioral health and substance use disorder services in South Dakota.

You will verify insurance, submit claims, monitor the revenue cycle, and coordinate with admissions, clinical, and leadership teams to ensure compliant documentation and timely reimbursement.