PA IBHS Compliance & Billing Lead

REACHING BEYOND LIMITS; Wilkes-Barre (Luzerne County); On-site; USD 70,000 - 105,000; Full time

Job summary

Reaching Beyond Limits is seeking an experienced IBHS Compliance and Billing Officer to oversee regulatory compliance, quality assurance, clinical documentation, billing operations, and revenue-cycle processes for its Pennsylvania Intensive Behavioral Health Services program.

The ideal candidate will have direct experience with Pennsylvania Medical Assistance, HealthChoices, behavioral-health billing, service authorizations, claim submission, denial resolution, and regulatory compliance.

Qualifications

• Bachelor's degree in healthcare administration, behavioral health, or related field.
• 3+ years of healthcare or behavioral-health billing, revenue-cycle, compliance, auditing, or quality-assurance experience.
• Direct experience with Pennsylvania Medical Assistance or Medicaid billing.
• Knowledge of behavioral-health service authorizations, claim submission, remittance advice, denials, corrections, resubmissions, and AR.
• HIPAA, confidentiality, fraud, waste and abuse, exclusions screening, incident reporting, and healthcare compliance familiarity.

Responsibilities

• Oversee compliance, quality assurance, and billing operations for IBHS program.
• Monitor 55 Pa. Code Chapter 5240 and other IBHS requirements.
• Conduct audits of clinical, billing, authorization, and administrative records to ensure compliance.
• Review clinical records for medical necessity, signatures, and payer requirements.
• Prepare for OMHSAS licensing reviews and managed care audits, and respond to findings.

Skills

Regulatory compliance

Billing operations

Auditing

Quality assurance

Healthcare analytics

Education

Bachelor's degree in healthcare administration

Tools

CentralReach

Job description

Reaching Beyond Limits is seeking an experienced IBHS Compliance and Billing Officer to oversee regulatory compliance, quality assurance, clinical documentation, billing operations, and revenue-cycle processes for its Pennsylvania Intensive Behavioral Health Services program.

The ideal candidate will have direct experience with Pennsylvania Medical Assistance, HealthChoices, behavioral-health billing, service authorizations, claim submission, denial resolution, and regulatory compliance.