Billing & Credentialing Specialist

Position Overview

We are seeking a detail-oriented and experienced Billing Specialist to join our inclusive and affirming mental health practice. This position is essential to maintaining a smooth revenue cycle through accurate claims processing, efficient billing operations, and proactive communication with payers and clients. The ideal candidate will have a strong understanding of mental health billing procedures, including Ohio Medicaid, and will be comfortable working independently in a remote setting.

Key Responsibilities

Claims Processing & Revenue Cycle Management

Correct and submit unbilled claims due to missing diagnostic codes, signatures, or pending statuses.

Monitor claim status and follow up on rejections or denials; resubmit and appeal as needed.

Contact payers regarding overpayments, underpayments, and recoupments within 30 days of identification.

Process insurance write-offs for issues such as duplicates or payer errors.

Update and maintain billing rules with the Revenue Cycle Management (RCM) vendor to improve billing efficiency.

Client Billing & Accounts Management

Ensure client demographic and insurance information is accurate and current in the EHR system.

Perform monthly insurance verifications for active clients.

Address client billing inquiries professionally and provide timely resolution.

Manage accounts receivable and support collections activity as needed.

Maintain accurate billing logs, internal billing notes, and documentation in compliance with agency policies.

Collaboration & Compliance

Collaborate with clinical staff to ensure documentation and coding support timely and accurate billing.

Ensure compliance with Ohio Administrative Code (OAC), Ohio Revised Code (ORC), Medicaid requirements, and HIPAA standards.

Stay informed of Ohio Medicaid policy updates and implement necessary billing adjustments.

Support financial audits, compliance checks, and credentialing-related billing reviews.

Reporting & System Management

Utilize ClinicTracker (EHR) to process claims and track financial data.

Generate, review, and submit regular reports to monitor revenue performance and billing trends.

Credentialing & Provider Enrollment

Assist with credentialing individual providers with Ohio Medicaid and private insurance carriers.

Track and maintain credentialing application statuses, revalidations, and renewals.

Collaborate with providers and administrative staff to ensure timely submission of credentialing paperwork.

Maintain accurate records of credentialing documentation in compliance with payer and regulatory requirements.

Communicate with carriers to resolve credentialing or enrollment-related issues affecting billing or reimbursement.

Qualifications

Minimum 2 years of experience in medical billing, preferably in behavioral health or mental health services.

Strong understanding of Ohio Medicaid billing guidelines and third-party insurance claim processes.

Proficiency in EHR systems such as ClinicTracker, CareLogic, or inSync

Working knowledge of CPT/ICD-10 coding, insurance authorization, and HIPAA compliance.

Excellent communication and interpersonal skills.

High level of accuracy, attention to detail, and ability to meet deadlines.

Comfortable using inclusive, affirming, and culturally responsive language.

Must meet all privacy and security requirements for remote work.