Medical Biller - Behavioral Health

Position Summary

We are seeking an experienced Medical Biller with strong behavioral health revenue cycle experience to join our Revenue Cycle Management team. The ideal candidate will have extensive knowledge of medical

billing, coding, claim submission, and payer-specific billing requirements for behavioral health and substance use disorder (SUD) services. This position requires a highly detail-orientedprofessional who understands the differences among Commercial, Medicaid, VA, and TRICARE billing requirements

and can accurately submit claims across multiple levels of care. The Biller will be responsible for ensuring claims are accurately coded, properly formatted, and successfully accepted by the

appropriate payer. Once a claim has been successfully accepted by the payer, responsibility for continued follow-up, denial management, payment posting, and resolution transfers to the Collections team.

Key Responsibilities

Prepare, review, and submit accurate medical claims for behavioral health and SUD services.

Process claims for Commercial, Medicaid, VA, and TRICARE payers. Demonstrate strong understanding of behavioral health levels of care, including:

• Outpatient (OP)
• Intensive Outpatient Program (IOP)
• Partial Hospitalization Program (PHP)
• Inpatient services, when applicable
• Other behavioral health/SUD services as assigned

Apply appropriate CPT, HCPCS, revenue codes, modifiers, diagnosis codes, place-of-service codes, and payer-specific billing requirements. Understand and appropriately bill facility-based and professional

services. Review patient accounts and supporting documentation for billing accuracy prior to claim submission. Identify missing, inconsistent, or incorrect information that could result in claim rejection or denial. Verify payer-specific requirements, including authorization, eligibility, provider/facility requirements, claim forms, and billing guidelines. Submit claims electronically through the appropriate clearinghouse or payer portal. Monitor claim submission status and address rejected or unaccepted claims promptly.

Utilize Integrated Billing, including the integration between Kipu and CollaborateMD, as part of the organization’s billing audit and claim-quality control process.

Perform pre-billing audits to identify potential billing errors before claims are submitted.

Research payer requirements and make appropriate billing corrections.

Maintain accurate billing records and documentation.

Work collaboratively with Benefits Verification, Utilization Review, Collections, Clinical, and Revenue Cycle leadership teams.Escalate recurring billing issues, payer trends, system issues, and significant claim-quality concerns to management.

Meet established productivity, accuracy, and turnaround-time expectations.

Claim Submission & Workflow Accountability

This position is specifically responsible for the front-end claim submission process.

The Biller’s responsibility includes:

Documentation → Coding → Claim Creation → Claim Review →

Claim Submission → Successful Payer Acceptance

Required Qualifications

Minimum 3–5 years of medical billing experience; behavioral health experience strongly preferred.

Extensive knowledge of behavioral health and SUD billing. Strong understanding of Commercial, Medicaid, VA, and TRICARE billing.

Working knowledge of CPT, HCPCS, ICD-10-CM, modifiers, revenue codes, and claim forms.

Experience billing facility-based behavioral health services.

Experience with electronic claim submission and clearinghouses.

Strong understanding of payer-specific billing requirements.

Ability to identify claim errors and determine appropriate corrections before submission.

Strong computer skills and ability to work across multiple billing and payer systems.

Excellent attention to detail and accuracy.

Strong organizational and time-management skills.Ability to manage high-volume claim submission while

maintaining quality.

Ability to work independently while collaborating effectively with a remote or centralized Revenue Cycle team.

Preferred Qualifications

Experience with Kipu.

Experience with CollaborateMD.

Experience using Integrated Billing or similar billing audit/claim-quality tools.

Experience working with multiple behavioral health facilities or treatment centers.

Experience with out-of-network behavioral health billing.

Knowledge of payer-specific requirements for behavioral health and SUD services.

Experience identifying systemic billing issues and recommending process improvements.

What Success Looks Like

Success in this position means claims leave the billing department clean, accurate, compliant, and accepted by the payer.

The successful candidate will consistently:

Submit accurate claims within established turnaround times.

Maintain high first-pass claim acceptance rates.

Minimize preventable claim rejections.

Identify billing errors before submission.

Properly apply payer-specific billing requirements.

Maintain accurate and complete billing documentation.

Communicate recurring billing issues to leadership.

Meet departmental productivity and quality standards.

Contribute to a disciplined, efficient revenue cycle workflow.

Key Performance Expectations

Performance will be evaluated using measurable Revenue Cycle

KPIs, including:

Claim submission volume

Claim submission turnaround time

First-pass acceptance rate

Claim rejection rate

Billing accuracy

Error rate

Timeliness of corrected claim submission

Productivity

Compliance with payer and internal billing requirements

Why Join Us?

This is an opportunity to join a growing behavioral health organization where accurate billing directly contributes to the organization’s financial health and ability to provide quality care. We value professionals who take ownership of their work, understand the importance of clean claims and revenue integrity, and are committed to building an efficient, accountable Revenue Cycle operation.

If you know behavioral health billing inside and out—and you can tell a clean claim from a future headache—we want to hear from you!!

Equal Opportunity Employer

We are an Equal Opportunity Employer and consider qualified applicants without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other legally protected status.