Billing Specialist

TeemaGroup; City of White Plains (NY); On-site; USD 50,000 - 70,000; Full time

Job summary

A healthcare solutions provider based in White Plains is looking for a Prior Authorization & Billing Specialist to manage insurance authorizations and billing processes for mental health services. The ideal candidate has a minimum of 2 years' experience in prior authorization or medical billing, preferably in behavioral health. Strong organizational, communication, and detail-oriented skills are essential in this role, along with proficiency in EHR systems and billing software.

Qualifications

• Minimum of 2 years of experience in prior authorization or medical billing.
• Experience in mental health or behavioral health services is preferred.

Responsibilities

• Manage authorizations for mental health services.
• Submit claims to commercial, Medicaid, and Medicare payers.
• Maintain compliance with HIPAA and payer contracts.

Skills

Prior authorization processes

Behavioral health billing practices

Attention to detail

Organizational skills

Communication skills

Education

High school diploma or equivalent

Associate or bachelor's degree in healthcare administration

Tools

EHR systems

Billing software

Microsoft Office applications

Job description

Overview

The Prior Authorization & Billing Specialist plays a critical role in ensuring timely access to mental health services by managing insurance authorizations, billing processes, and reimbursement workflows. This position serves as a key liaison between clinical teams, insurance payers, and patients, ensuring services are authorized, accurately billed, and compliant with regulatory and payer requirements. This role is ideal for a detail-oriented professional passionate about supporting behavioral health access through strong administrative and revenue cycle expertise.

What you will be doing

• Obtain and manage prior authorizations for outpatient and inpatient mental health services, including therapy, psychiatry, psychological testing, and intensive programs.
• Review clinical documentation to ensure medical necessity and payer compliance.
• Submit authorization requests to insurance companies via portals, phone, or electronic systems.
• Track authorization approvals, denials, expirations, and extensions; proactively follow up to prevent treatment delays.
• Communicate authorization status clearly with clinicians, scheduling staff, and leadership.
• Assist with peer-to-peer reviews and appeals when authorization is denied or partially approved.
• Submit accurate and timely claims for mental health services to commercial, Medicaid, and Medicare payers.
• Verify insurance eligibility, benefits, and coverage limitations prior to services.
• Review Explanation of Benefits (EOBs) and remittance advice for accuracy.
• Identify, research, and resolve claim denials, underpayments, and rejections.
• Post payments and adjustments accurately when applicable.
• Maintain compliance with CPT, ICD-10, and modifier guidelines specific to behavioral health billing.

Administrative & Compliance Responsibilities

• Maintain accurate patient authorization and billing records within electronic health record (EHR) and billing systems.
• Ensure compliance with HIPAA, payer contracts, and internal policies.
• Collaborate with clinical, administrative, and finance teams to optimize workflows and reduce revenue leakage.
• Monitor payer requirements, policy changes, and authorization rules related to mental health services.
• Prepare reports related to authorization turnaround times, denial trends, and billing performance.
• Perform other related duties as assigned.

What you must have

Education and Experience

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or related field preferred.
• Minimum of 2 years of experience in prior authorization, utilization review, medical billing, or revenue cycle operations.
• Experience in mental health or behavioral health services strongly preferred.

Knowledge, Skills, and Abilities

• Strong understanding of prior authorization processes and insurance requirements.
• Knowledge of behavioral health billing practices, CPT and ICD-10 coding, and payer guidelines.
• Excellent attention to detail and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong written and verbal communication skills, including professional interaction with payers and clinical staff.
• Ability to work independently while collaborating effectively with a team.
• Proficiency with EHR systems, billing software, and Microsoft Office applications.