Mental Health Billing Specialist – Denials, Credentialing, & Insurance

Evolve Managed Care Solutions; Augusta (GA); On-site; USD 40,000 - 60,000; Full time

Job summary

An established industry player in mental health services is searching for a dedicated Mental Health Billing Specialist. This role is crucial for managing claim denials, insurance credentialing, and billing compliance, ensuring financial success and accessibility of care for patients. The ideal candidate will have a solid background in medical billing within a behavioral health context, excellent problem-solving abilities, and familiarity with electronic billing systems. Join a team committed to delivering high-quality mental health care while optimizing revenue through effective claims management and compliance. This position offers a chance to make a significant impact in the lives of patients and the overall success of the practice.

Qualifications

• 2-3 years of experience in medical billing focused on mental health services.
• Strong understanding of insurance credentialing and payer requirements.

Responsibilities

• Manage claim denials, appeals, and insurance credentialing processes.
• Utilize HCA Clinical Works for billing and claims processing.

Skills

Denials Management

Insurance Credentialing

Verification

Problem-Solving Skills

Communication Skills

Organizational Skills

Education

Certification in Medical Billing & Coding (CPC, CPB, or similar)

Tools

eClinical Works

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.