BEHAVIORAL HEALTH MEDICAL BILLING SPECIALIST

Preferred Behavioral Health Of New Jersey; Toms River (NJ); On-site; USD 60,000 - 70,000; Full time

Benefits offered by this job

Health insurance

403(b) Retirement Plan

Paid time off

Long-term disability

Life and AD&D insurance

Employee assistance program

FSAs/HSA

Job summary

Preferred Behavioral Health Group is seeking a Behavioral Health Medical Billing Specialist in Toms River, NJ. The role requires at least 1 year in behavioral health billing, with knowledge of commercial, Medicare, and Medicaid billing and regulatory requirements.

Responsibilities include submitting claims, handling denials, and coordinating with payors and EHR systems to ensure accurate reimbursements. This is a full-time position with a focus on accuracy and compliance.

Qualifications

• Requires 1+ year in behavioral health billing.
• Experience in nonprofit behavioral health settings preferred.
• Knowledge of commercial, Medicare, Medicaid billing and regulations.

Responsibilities

• Submit claims to commercial, Medicare and Medicaid payors per payer rules.
• Process claim corrections, rebills, and secondary claims.
• Investigate denials and pursue appeals and corrective actions.

Skills

Behavioral health billing

A/R management

Payer negotiations

HIPAA compliance

Claims denial resolution

Education

High school diploma

Billing/Coding certificates (CPB, CMRS)

Tools

NJMHAPP

DAS

Inovalon clearinghouse

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

BEHAVIORAL HEALTH MEDICAL BILLING SPECIALIST

ADMIN PBH Full Time Toms River - Hyers St, Toms River, NJ, US

Salary Range: $60,000.00 To $70,000.00 Annually

If you are looking to make an impact by helping others, then Preferred Behavioral Health Group is the place for you! By joining our award-winning team, you will become part of the premier behavioral health organization in New Jersey. PBHG is a dynamic and innovative non-profit organization that was proudly named one of "THE BEST PLACES TO WORK IN NEW JERSEY" for BOTH 2024 and 2025 by NJBIZ! Our mission is to change lives and save lives across the state of New Jersey through a Trauma Informed Care culture.

Our staff is at the core of everything we do. We are dedicated to building a diverse team where employees feel a sense of belonging and are valued for their individual contributions. We encourage staff development and embrace a growth mindset. If you are interested in pursuing an exciting and rewarding career while being part of a recognized “Best Place to Work”,

Job Title: Behavioral Health Medical Billing Specialist

location: Office 52 Hyers Street, Toms River New Jersey

Position Type: Full Time

Job Description/Summary

We are seeking an experienced, detail-oriented Behavioral Health Medical Billing Specialist with at least 1 year of behavioral health billing experience. The ideal candidate will have experience in non-profit behavioral health organizations and possess knowledge of commercial, Medicare, and Medicaid. This role requires accuracy and the ability to navigate in complex billing environments. Experience with NJMHAPP, DAS, Federal Probation, and Inovalon clearinghouse a plus.

Responsibilities

• Submit claims to commercial, Medicare, Medicaid, state, and county payors, following payer-specific rules and regulations.
• Process claim corrections, rebills, and secondary insurance claims in accordance with payer guidelines.
• Investigate and resolve claim denials, rejections, and underpayments through payer appeals and corrective action.Use payer portals for claim submission, eligibility checks, and claims follow-up.
• Review payer rejections and reporting in clearinghouse.
• Maintain up-to-date knowledge of behavioral health billing codes, compliance with HIPAA CMS, and all other federal, state, and local billing regulations., and regulatory changes.
• Review and send patient statements; manage delinquent accounts
• Assist clients with insurance-related inquiries, benefit explanations, and payment responsibility discussions.
• Monitor accounts receivable (A/R) and pursue outstanding claims to reduce aging balances and improve cash flow.
• Verify insurance eligibility, benefits, authorizations, and coverage requirements prior to service delivery.
• Reconcile Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERA) payments to ensure accurate reimbursement.
• Coordinate with providers, credentialing teams, and insurance carriers to resolve enrollment and billing issues.
• Minimum of 1 year of behavioral health insurance billing experience.
• Experience in non-profit behavioral health settings .
• Proficiency with billing commercial insurance, Managed Care, Medicare, Medicare Supplementals and Medigap, MedicaidExperience with NJMHAPP, DAS, Federal Probation, and Inovalon clearinghouse a plus.

Qualifications

• High school diploma or equivalent required.
• Billing Coding Certificates (CPB, CMRS, or equivalent) are preferred.

Knowledge & Technical Skills

• In-depth understanding of CPT, ICD-10, and HCPCS coding standards.
• Knowledge of clearinghouse, Inovalon experience preferred.
• Strong understanding of payer regulations and behavioral health billing requirements.
• Use a trauma informed approach to all client financial concerns.
• Familiarity with claim submission processes, billing software, EHR systems.
• Strong problem-solving skills for resolving complex billing and reimbursement issues.
• Knowledge of EDI and clearinghouse configuration a plus.

• Medical, Dental and Prescription Insurance
• 403(b) Retirement Plan
• Generous Paid Time Off and Paid Holidays
• Long Term Disability Insurance
• Life and AD&D Insurance
• Employee Assistance Program
• Flexible Spending Account and Health Savings Account
• Voluntary Benefits, such as Vision Insurance, Aflac, Pet Insurance
• Staff Training and Development Opportunities