Behavioral Health Medical Biller, Accounts Receivable, and Administrative Support Specialist

Behavioral Health Medical Biller, Accounts Receivable, and Administrative Support Specialist Part time 16-20 hours to start once fully trained 40 hours per week Job Overview Meridian Behavioral Health is seeking an experienced behavioral health medical biller and accounts receivable specialist to support our growing outpatient mental health practice. We are currently a small practice with two providers and anticipate growing to approximately seven providers. We need someone who can manage billing responsibilities accurately, investigate unpaid or incorrectly paid claims, help maintain Medicaid-compliant documentation, and provide dependable administrative support. This is not an entry-level billing position. The ideal candidate will have direct experience with behavioral health billing, Nevada Medicaid fee-for-service claims, commercial insurance claims, accounts receivable follow-up, claim reconsiderations, prior authorizations, and chart compliance reviews. The selected contractor must communicate professionally with patients, insurance companies, pharmacies, and healthcare providers. ## Primary Responsibilities ### Nevada Medicaid Fee-for-Service Billing * Prepare and submit Nevada Medicaid fee-for-service claims. * Review claims for accuracy before submission. * Verify that procedure codes, diagnosis codes, modifiers, provider information, service locations, and patient information are correct. * Identify and correct rejected, denied, or suspended claims. * Monitor claim status through final payment or resolution. * Follow Nevada Medicaid billing requirements and timely filing limits. * Maintain organized records of claim submissions, corrections, reconsiderations, and payer correspondence. ### Commercial Insurance Billing * Submit and monitor behavioral health claims to commercial insurance companies. * Review clearinghouse reports and correct claim rejections. * Investigate denied, underpaid, downcoded, bundled, or incorrectly processed claims. * Compare insurance payments with contracted rates, patient benefits, copayments, deductibles, and coinsurance responsibilities. * Identify situations in which an insurance company improperly reduced a procedure code or failed to pay according to the provider agreement. * Submit corrected claims, reconsiderations, appeals, and supporting documentation when appropriate. * Follow up with insurance companies until claims are resolved. ### Accounts Receivable Management * Review aging reports and identify unpaid or delayed claims. * Work accounts receivable balances by payer, date of service, provider, and aging category. * Contact insurance companies regarding unpaid, delayed, denied, or incorrectly processed claims. * Document every follow-up action clearly. * Prioritize claims approaching timely filing or appeal deadlines. * Identify recurring denial patterns and recommend workflow improvements. * Provide regular reports regarding outstanding balances, denials, underpayments, and recovered revenue. * Review patient balances for accuracy before patient statements or collection efforts. ### Medicaid Compliance and Chart Auditing * Review clinical charts for Nevada Medicaid documentation compliance. * Confirm that documentation supports the services and procedure codes billed. * Review records for required elements, including medical necessity, diagnosis, symptoms, functional impairment, treatment planning, interventions, patient response, risk assessment, and follow-up recommendations. * Identify missing, inconsistent, or potentially noncompliant documentation. * Provide clear feedback regarding documentation concerns without independently changing clinical documentation. * Help prepare records for payer audits, utilization reviews, and documentation requests. * Track audit requests and submission deadlines. * Maintain strict confidentiality and follow all applicable privacy and security requirements. ### Prior Authorizations * Complete and submit prior authorization requests for psychiatric medications and other covered services when required. * Contact insurance plans to determine prior authorization requirements. * Gather necessary clinical and insurance information from the provider or medical record. * Submit supporting documentation and monitor authorization status. * Respond to requests for additional information. * Assist with appeals or reconsiderations for denied authorizations. * Maintain accurate records of authorization numbers, approval dates, expiration dates, and covered services. ### Pharmacy Communication * Communicate professionally with pharmacies when necessary and when authorized by the practice. * Assist with resolving insurance-related medication processing issues. * Confirm receipt of prescriptions or prior authorization determinations when appropriate. * Relay nonclinical pharmacy messages to the prescribing provider. * Do not provide clinical advice or independently approve medication changes. ### Telephone and Administrative Support * Assist with approximately 40 inbound and outbound calls per week. * Return calls to patients, insurance companies, pharmacies, and other authorized parties. * Communicate clearly and professionally in English. * Document calls and follow-up actions accurately. * Route clinical questions to the appropriate provider. * Assist patients with general scheduling, insurance, billing, portal, and administrative questions. * Maintain professional boundaries and avoid providing clinical advice. * Protect patient privacy during all telephone and electronic communications. ## Required Qualifications * Demonstrated professional experience in medical billing and accounts receivable. * Direct experience billing outpatient behavioral health or psychiatric services. * Experience with Nevada Medicaid fee-for-service billing. * Experience with commercial insurance claim submission and follow-up. * Strong knowledge of claim denials, downcoding, underpayments, reconsiderations, corrected claims, and appeals. * Experience reviewing explanation of benefits and electronic remittance advice documents. * Experience working accounts receivable aging reports. * Knowledge of behavioral health procedure codes and diagnosis coding. * Experience with prior authorizations, especially psychiatric medication authorizations. * Ability to review charts for billing and Medicaid documentation compliance. * Professional telephone communication skills. * Full professional fluency in written and spoken English. * Strong attention to detail and ability to follow written procedures. * Ability to work independently and communicate concerns promptly. * Reliable computer, secure workspace, dependable high-speed Internet connection, and working telephone or headset. * Ability to maintain confidentiality and comply with HIPAA and practice privacy requirements. * Availability to complete telephone work during agreed-upon Pacific Time business hours. ## Preferred Qualifications * Experience with SimplePractice. * Experience with Nevada Medicaid provider portals. * Experience with Availity and insurance payer portals. * Experience with psychiatric evaluations, medication-management claims, and psychotherapy billing. * Familiarity with procedure codes such as 90791, 90792, 90833, 90834, 90837, 99213, 99214, and related behavioral health services. * Experience identifying payer contract discrepancies and fee-schedule underpayments. * Experience supporting a growing behavioral health group practice. * Certified Professional Biller, Certified Professional Coder, or comparable billing certification. ## Technology and Privacy Requirements Because this position involves protected health information, the contractor must: * Use a password-protected computer that is not shared with unauthorized individuals. * Maintain updated security software. * Use a private and secure Internet connection. * Avoid working with patient information in public locations. * Follow all practice privacy, security, and access-control requirements. * Immediately report suspected privacy, security, or billing concerns. * Complete any required confidentiality, HIPAA, or business associate documentation before receiving access to patient information. ## What Success Looks Like The successful contractor will: * Submit clean claims accurately and on time. * Reduce claim denials and unresolved accounts receivable. * Identify underpayments and improper downcoding. * Recover revenue through effective follow-up and reconsiderations. * Maintain organized billing and authorization records. * Identify documentation risks before they become audit problems. * Communicate professionally with patients, payers, providers, and pharmacies. * Help create billing processes that can support growth from two providers to approximately seven providers. ## Contractor Expectations * Maintain consistent communication regarding completed work and unresolved issues. * Provide written updates on claims, denials, accounts receivable, authorizations, and audit concerns. * Ask for clarification rather than making unsupported assumptions. * Meet all assigned deadlines and timely filing requirements. * Follow practice policies and obtain provider approval before submitting clinical information that requires review. * Maintain accurate records of all work completed. ## Information to Include in Your Proposal Please answer the following questions: 1. How many years of medical billing and accounts receivable experience do you have? 2. Describe your experience with outpatient behavioral health or psychiatric billing. 3. What experience do you have submitting Nevada Medicaid fee-for-service claims? 4. Which Nevada Medicaid, clearinghouse, electronic health record, and payer portals have you used? 5. Describe a situation in which you identified an underpaid or improperly downcoded claim and how you resolved it. 6. What is your process for managing accounts receivable balances that are more than 30, 60, or 90 days old? 7. What experience do you have reviewing clinical documentation for Medicaid compliance? 8. What experience do you have completing psychiatric medication prior authorizations? 9. Are you comfortable making and receiving approximately 40 professional calls per week? 10. What hours are you available during the Pacific Time Zone? 11. Do you have a private workspace, reliable computer, secure Internet connection, and telephone headset? 12. Are you willing to sign confidentiality, HIPAA, and business associate agreements? 13. Please provide examples of behavioral health procedure codes you have billed. 14. Please describe how you protect patient information while working remotely. Applications that do not address Nevada Medicaid billing, behavioral health billing, accounts receivable, and telephone availability may not be considered.