Behavioral Health Outpatient Billing Specialist

Job Summary

The Behavioral Health Billing Specialist is responsible for accurate and timely billing, claims submission, payment posting, and follow-up for behavioral health services. This role ensures compliance with payer requirements, state and federal regulations, and organizational policies while maximizing reimbursement and minimizing denials.

Key Responsibilities

? Prepare, submit, and manage claims for behavioral health services (mental health and/or substance use treatment) to Medicaid, Medicare, and commercial insurance payers

? Verify patient insurance eligibility, benefits, authorizations, and coverage requirements

? Ensure services are billed accurately using appropriate CPT, HCPCS, ICD-10, and place-of-service codes

? Review clinical documentation to support prior authorization submissions and ensure compliance with payer authorization guidelines.

? Post payments, adjustments, and denials accurately in the billing system

? Identify, research, and resolve claim denials, underpayments, and rejections

? Submit appeals and corrected claims as necessary within payer deadlines

? Monitor accounts receivable and follow up on outstanding claims to ensure timely reimbursement

? Communicate effectively with clinicians, supervisors, and insurance representatives regarding billing issues

Required Qualifications

? High school diploma or equivalent

? Minimum of 1–2 years of medical billing experience, preferably in behavioral or mental health

? Knowledge of behavioral health billing codes, modifiers, and documentation requirements

? Familiarity with Medicaid, Medicare, and commercial insurance billing processes

? Experience with electronic health record (EHR) and practice management systems

? Strong attention to detail and accuracy

? Ability to manage multiple tasks and meet deadlines Preferred Qualifications

? Experience billing behavioral health and mental health services, including SAIOP, SACOT, and Peer Support. Experience with inpatient billing for facility-based crisis services, residential treatment, and detoxification is preferred but not required.

? Skills & Competencies

? Strong analytical and problem-solving skills

? Excellent written and verbal communication skills

? Ability to work independently and as part of a team

? Confidentiality and professionalism when handling sensitive patient information

? Proficiency in Microsoft Office (Excel, Word)

Preferred Qualifications

• Experience with outpatient behavioral health billing.
• Experience billing Intensive Outpatient Program (IOP) and Substance Abuse Comprehensive Outpatient Treatment (SACOT) services preferred, but not required.
• Familiarity with behavioral health payer requirements, authorization processes, and claims submission.