Medical Billing Specialist

Job Description This is a remote position. Position Overview We are seeking an experienced and highly organized Medical Billing Specialist to independently manage insurance billing for a behavioral health practice. The ideal candidate will have strong knowledge of the complete medical billing cycle and be capable of managing claims, denials, insurance follow-ups, payment posting, and credentialing with minimal supervision. This position requires someone who can identify and resolve billing issues proactively, maintain accurate records, and communicate consistently with practice leadership. This role will focus primarily on billing and insurance-related responsibilities, with minimal patient interaction. Key Responsibilities ● Submit accurate and timely insurance claims through the practice’s EMR and applicable clearinghouses ● Review claims for accuracy, completeness, and proper documentation before submission ● Monitor outstanding claims and follow up with insurance companies regarding unpaid, delayed, or rejected claims ● Investigate claim denials, identify the cause, and complete corrections, resubmissions, or appeals ● Verify claim status through payer portals, clearinghouses, and direct insurance follow-up ● Post insurance payments, electronic remittance advice, and adjustments accurately ● Reconcile payments and identify underpayments, discrepancies, or missing reimbursements ● Manage accounts receivable aging and prioritize claims requiring immediate attention ● Support provider enrollment, recredentialing, and insurance credentialing processes ● Maintain provider CAQH profiles, including quarterly attestations, license renewals, and malpractice insurance certificate of insurance (COI) uploads ● Review and resolve front-end clearinghouse rejections daily to prevent claim delays ● Maintain organized records of claims, denials, payments, follow-ups, and credentialing activity ● Communicate billing issues, trends, and unresolved items clearly to practice leadership ● Provide regular updates on outstanding claims and actions taken ● Protect patient and practice information in accordance with HIPAA requirements and internal policies ● Learn and follow the practice’s existing billing workflows and procedures Required Qualifications ● At least 2 years of medical billing experience ● Strong understanding of the complete medical billing and revenue cycle process ● Experience submitting and managing insurance claims ● Experience resolving rejected and denied claims ● Knowledge of insurance follow-up, appeals, payment posting, and accounts receivable ● Familiarity with payer portals, clearinghouses, and electronic remittance systems ● Experience with platforms such as Availity, ECHO Health, Zelis, or similar systems ● Experience managing CAQH ProView attestations, document uploads, and NPPES/NPI record updates ● Experience navigating behavioral health payer portals including Optum/PayMyHealth (United Behavioral Health), Beacon/Carelon, Magellan, state Medicaid/MCO portals, and Availity ● Familiarity with clearinghouses including Change Healthcare, Waystar, TriZetto, and Office Ally ● Working knowledge of provider credentialing and recredentialing ● Understanding of HIPAA requirements and patient information confidentiality ● Strong written and verbal English communication skills ● Excellent organization, documentation, and follow-up skills ● Ability to work independently with minimal supervision ● Strong problem-solving skills and attention to detail ● Reliable internet connection and a professional remote work environment Preferred Qualifications ● Experience supporting a behavioral health or mental health practice ● Experience with commercial insurance billing ● Familiarity with behavioral health billing codes and insurance requirements ● Experience managing billing responsibilities for a small or independently operated practice ● Experience transitioning billing responsibilities from an outside billing company ● Familiarity with Ritten or similar behavioral health EMR platforms Prior experience with Ritten is not required. Training on the practice’s specific EMR and internal workflow will be provided. Ideal Candidate The ideal candidate is not simply a data-entry biller. We are looking for someone who understands insurance billing well enough to investigate problems, communicate with payers, resolve issues, and keep claims from falling behind. This person should be proactive, dependable, and comfortable taking ownership of the billing process. They should communicate clearly when issues arise, provide consistent updates, and require minimal day-to-day management.