Mental Health Billing Specialist – Denials, Credentialing, & Insurance

Evolve Managed Care Solutions; Augusta (GA); On-site; USD 40,000 - 55,000; Full time

Job summary

Evolve Managed Care Solutions in Augusta, GA is seeking an experienced Mental Health Billing Specialist. The role focuses on managing claim denials, appeals, and insurance credentialing to ensure the financial success of our practice while maintaining patient care accessibility.

Candidates should possess at least 2-3 years of medical billing experience in behavioral health and a strong familiarity with HCA Clinical Works. Strong problem-solving and organizational skills are essential for success in this role.

Qualifications

• Minimum 2-3 years of experience in medical billing, especially in behavioral health.
• Strong understanding of insurance credentialing and provider enrollment.
• Proficient in analyzing denial trends and implementing solutions.

Responsibilities

• Manage claim denials, appeals, and the insurance credentialing process.
• Track and resolve denied claims, ensuring compliance with payer guidelines.
• Verify insurance for new and existing patients, confirming coverage details.

Skills

Denials management

Insurance credentialing

Problem-solving skills

Communication skills

Organizational skills

Knowledge of CPT codes

Knowledge of ICD-10 coding

Education

2-3 years of experience in medical billing

Certification in Medical Billing & Coding (CPC, CPB)

Tools

HCA Clinical Works

Job description

About Us

Evolve is a trusted psychiatric and behavioral health service provider committed to delivering high-quality mental health care to our patients. We are seeking an experienced mental Health Billing Specialist with expertise in denials management, insurance credentialing, verification, and experience with eClinical Works. This role is essential to ensuring the financial success of our practice and the accessibility of care for our patients.

Position Overview

The Mental Health Billing Specialist will be responsible for managing claim denials, appeals, insurance credentialing, and verification processes. The ideal candidate has a strong background in medical billing within a behavioral health setting, excellent problem-solving skills, and a deep understanding of HCA Clinical Works.

Key Responsibilities

Billing & Denials Management

• Review, analyze, and resolve denied or underpaid claims in a timely manner.
• Prepare and submit appeals for denied claims, ensuring compliance with payer guidelines.
• Track and follow up on outstanding claims, correcting errors to secure payment.
• Work closely with insurance companies to identify trends in denials and implement corrective actions.

Insurance Credentialing & Verification

• Manage provider credentialing and re-credentialing processes with Medicaid, Medicare, and commercial payers.
• Ensure all provider credentials are up to date and compliant with insurance company requirements.
• Conduct insurance verification for new and existing patients, confirming benefits, eligibility, and coverage details.
• Maintain detailed records of provider contracts, enrollment status, and credentialing applications.

General Billing & Compliance

• Utilize HCA Clinical Works for billing, claims processing, and account reconciliation.
• Maintain compliance with HIPAA, payer policies, and industry regulations.
• Assist with patient billing inquiries and develop payment plans as needed.
• Generate reports on claim status, denials, credentialing progress, and revenue cycle trends.

Qualifications & Experience

• Minimum 2-3 years of experience in medical billing, with a focus on mental health or behavioral health services.
• Proven experience in denials management, appeals, and insurance follow-up.
• Strong understanding of insurance credentialing, provider enrollment, and payer requirements.
• Proficiency in HCA Clinical Works and other electronic billing systems.
• Familiarity with Medicaid, Medicare, and commercial insurance payers.
• Knowledge of CPT codes, ICD-10 coding, and mental health billing regulations.
• Ability to analyze denial trends and implement solutions to optimize revenue.
• Excellent problem-solving, communication, and organizational skills.

Preferred Qualifications

• Certification in Medical Billing & Coding (CPC, CPB, or similar) is a plus.
• Experience working in a psychiatric or behavioral health practice.
• Knowledge of prior authorization processes for mental health services.