BEHAVIORAL HEALTH MEDICAL BILLING SPECIALIST

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

Benefits offered by this job

Medical, Dental and Prescription 보험

403(b) Retirement Plan

Paid Time Off and Holidays

Long Term Disability Insurance

Life and AD&D Insurance

Employee Assistance Program

Flexible Spending Account

Health Savings Account

Vision Insurance (Voluntary)

Aflac

Pet Insurance

Staff Training and DevelopmentOpportun

Employee Referral Bonus program

Job summary

Preferred Behavioral Health Group is seeking a Behavioral Health Medical Billing Specialist for our office in Toms River, NJ. This full-time role focuses on submitting and reconciling claims across commercial, Medicare, and Medicaid payors within a trauma-informed, non-profit environment.

The ideal candidate has at least 1 year of behavioral health billing experience, CPT/ICD-10/HCPCS knowledge, and fluency with clearinghouse and EHR systems. Competitive benefits apply.

Qualifications

• Minimum of 1 year of behavioral health billing experience.
• Experience with commercial, Medicare, and Medicaid billing.
• Knowledge of CPT, ICD-10, and HCPCS coding standards.

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 and HIPAA CMS compliance and all other billing regulations.
• 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 EOBs and ERA payments to ensure accurate reimbursement.
• Coordinate with providers, credentialing teams, and insurance carriers to resolve enrollment and billing issues.

Skills

Attention to detail

Customer service skills

HIPAA compliance

Education

High school diploma or equivalent

Billing Coding Certificates (CPB, CMRS, or equivalent)

Tools

Billing software

EHR systems

Clearinghouse platforms (Inovalon, DAS, NJMHAPP)

EDI knowledge

Job description

Preferred Behavioral Health GroupIf 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", please submit your resume today for consideration!

Behavioral Health Medical Billing Specialist

Program: Billing DepartmentLocation: Office 52 Hyers Street, Toms River New JerseyPosition Type: Full TimeSalary: $60,000.00 - $70,000.00

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.

Competencies

• 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.
• Strong customer service skills.
• 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.

Comprehensive Benefits Package

• 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
• Employee Referral Bonus program