Medical Biller & Denial Specialist – Behavioral Health | Permanent WFH

We are seeking an experienced Medical Biller & Denial Specialist to join our growing Behavioral Health team. This role is responsible for managing the full medical billing cycle, with a strong focus on insurance billing, claims follow-up, denial resolution, appeals, and accounts receivable management.

The ideal candidate has hands-on experience with SimpleWorks EMR, a strong understanding of Behavioral Health billing processes, and the ability to work independently in a fast-paced healthcare environment while ensuring accurate and timely reimbursement.

Key Responsibilities

Medical Billing

• Prepare, review, and submit accurate insurance claims to commercial payers, Medicare, Medicaid, and other insurance carriers.
• Verify claim accuracy, including patient demographics, insurance information, CPT/HCPCS codes, ICD-10 codes, modifiers, and authorization requirements.
• Monitor claim status and perform timely follow-up on outstanding claims.
• Post and reconcile insurance payments, EOBs, and ERAs.
• Identify and correct billing discrepancies prior to claim submission.
• Maintain accurate billing documentation within SimpleWorks EMR.
• Follow up on unpaid, denied, and underpaid claims to ensure timely reimbursement.
• Manage assigned accounts receivable and work aging reports effectively.
• Communicate with insurance carriers regarding claim status, payment issues, and reimbursement inquiries.
  
  

Denial Management

• Review and analyze denied or rejected claims to determine root causes.
• Research payer policies, eligibility issues, authorization requirements, coding errors, and other denial-related concerns.
• Correct and resubmit claims as appropriate.
• Prepare and submit insurance appeals and reconsideration requests.
• Follow up on submitted appeals and unresolved payer issues.
• Track denial trends and identify recurring billing problems.
• Collaborate with internal staff to resolve issues contributing to claim denials.
• Maintain accurate documentation of denial activities and resolutions within the EMR and billing system.
• Prioritize high-dollar, aging, and timely filing claims to minimize revenue loss.
  
  

Qualifications

• 3+ years of medical billing and denial management experience
• Hands-on experience with SimpleWorks EMR (required)
• Strong understanding of the complete medical billing and revenue cycle process
• Demonstrated experience working insurance accounts receivable and resolving claim denials
• Knowledge of commercial insurance, Medicare, and Medicaid billing requirements
• Strong understanding of CPT, HCPCS, and ICD-10 coding concepts
• Experience researching payer requirements and correcting billing issues
• Excellent written and verbal communication skills
• Strong attention to detail and organizational abilities
• Ability to work independently while managing multiple payer accounts and priorities
• Proficiency in Microsoft Office and healthcare billing systems
• Experience with Behavioral Health, Psychiatry, Mental Health, Psychology, or Therapy practice billing
• Experience handling insurance appeals and reconsiderations
• Knowledge of payer-specific Behavioral Health billing requirements
• Experience working aging A/R reports and denial work queues
• Familiarity with authorization and referral-related billing issues
• Experience identifying denial trends and recommending process improvements
  
  

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary
  
  

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Who are we?

BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.