What are the responsibilities and job description for the Job Title: Medical Biller (Medicaid & MCO - Behavioral Health) position at Better Morning, Inc?
Better Morning emerged as an outpatient behavioral health practice in Ashburn, VA in the year of 2014.
In addition to providing counseling from the Ashburn office, Better Morning started off as a certified provider for intensive in home and community-based services (IHCBS), for at risk youth in District of Columbia.
In August of 2017, Better Morning was certified as a Core service agency (CSA) by DC Department of Behavioral Health. Better morning founder’s passion for at risk youth and their family were the motivation to keep expanding the evidenced based programs to meet the need of the underserved population.
Job Description
Position Summary
The Medicaid & MCO Biller is responsible for accurate and timely submission, tracking, and reconciliation of claims for services billed to DC Medicaid and Managed Care Organizations (MCOs). This role ensures compliance with District of Columbia Department of Health Care Finance (DHCF) regulations and payer-specific billing requirements while supporting revenue cycle efficiency.
Key Responsibilities
Eligibility & Authorization Verification:
Verify Medicaid eligibility using systems such as DC Access System or other payer portals.
Confirm MCO enrollment and service coverage prior to claim submission.
Track and manage prior authorizations and limitations.
Claims Submission & Processing
Submit clean claims to DC Medicaid and MCOs (e.g., AmeriHealth Caritas DC, MedStar Family Choice DC, Wellpoint, HSCSN)
Ensure proper use of CPT, HCPCS, and ICD-10 codes for behavioral health services.
Verify authorization requirements prior to billing (e.g., therapy, community support, medication management).
Denial Management & Follow-Up:
Review, analyze, and resolve denied or rejected claims.
Initiate timely appeals and resubmissions according to payer guidelines.
Track trends in denials and recommend corrective actions.
Payment Posting & Reconciliation:
Post payments, adjustments, and denials accurately from EOBs/ERAs.
Reconcile accounts receivable and identify discrepancies.
Maintain aging reports and escalate outstanding balances.
Compliance & Documentation:
Ensure billing practices comply with DHCF, Medicaid, and MCO guidelines.
Maintain audit-ready documentation (service notes, authorizations, consents).
Support internal and external audits (e.g., CARF, Medicaid reviews).
Collaboration:
Work closely with clinical, care coordination, and intake teams to ensure all required info and documentation is available for billing.
Provide feedback to staff on documentation errors affecting reimbursement.
Technical Skills:
Knowledge of CPT, ICD-10, and HCPCS coding.
Familiarity with EHR systems (e.g., Credible Behavioral Health or similar).
Proficiency in Office 365
Core Competencies:
Strong attention to detail and accuracy.
Knowledge of DC Medicaid regulations and MCO policies.
Problem-solving skills for denial resolution.
Ability to manage multiple payers and deadlines
Preferred Qualifications:
Experience with CARF-accredited organizations.
Familiarity with services such as:
Community Support Services (CSS),
Intensive in Home and Community Services(CBI)
Assertive Community Treatment (ACT)
Medication Management
Intensive Care Coordination (ICC)
Certification such as Certified Professional Biller (CPB) is a plus.
Qualifications:
High school diploma required; Associate’s or Bachelor’s degree preferred.
2 years of Medicaid billing experience, preferably in behavioral health or community-based services.
In addition to providing counseling from the Ashburn office, Better Morning started off as a certified provider for intensive in home and community-based services (IHCBS), for at risk youth in District of Columbia.
In August of 2017, Better Morning was certified as a Core service agency (CSA) by DC Department of Behavioral Health. Better morning founder’s passion for at risk youth and their family were the motivation to keep expanding the evidenced based programs to meet the need of the underserved population.
Job Description
Position Summary
The Medicaid & MCO Biller is responsible for accurate and timely submission, tracking, and reconciliation of claims for services billed to DC Medicaid and Managed Care Organizations (MCOs). This role ensures compliance with District of Columbia Department of Health Care Finance (DHCF) regulations and payer-specific billing requirements while supporting revenue cycle efficiency.
Key Responsibilities
Eligibility & Authorization Verification:
Verify Medicaid eligibility using systems such as DC Access System or other payer portals.
Confirm MCO enrollment and service coverage prior to claim submission.
Track and manage prior authorizations and limitations.
Claims Submission & Processing
Submit clean claims to DC Medicaid and MCOs (e.g., AmeriHealth Caritas DC, MedStar Family Choice DC, Wellpoint, HSCSN)
Ensure proper use of CPT, HCPCS, and ICD-10 codes for behavioral health services.
Verify authorization requirements prior to billing (e.g., therapy, community support, medication management).
Denial Management & Follow-Up:
Review, analyze, and resolve denied or rejected claims.
Initiate timely appeals and resubmissions according to payer guidelines.
Track trends in denials and recommend corrective actions.
Payment Posting & Reconciliation:
Post payments, adjustments, and denials accurately from EOBs/ERAs.
Reconcile accounts receivable and identify discrepancies.
Maintain aging reports and escalate outstanding balances.
Compliance & Documentation:
Ensure billing practices comply with DHCF, Medicaid, and MCO guidelines.
Maintain audit-ready documentation (service notes, authorizations, consents).
Support internal and external audits (e.g., CARF, Medicaid reviews).
Collaboration:
Work closely with clinical, care coordination, and intake teams to ensure all required info and documentation is available for billing.
Provide feedback to staff on documentation errors affecting reimbursement.
Technical Skills:
Knowledge of CPT, ICD-10, and HCPCS coding.
Familiarity with EHR systems (e.g., Credible Behavioral Health or similar).
Proficiency in Office 365
Core Competencies:
Strong attention to detail and accuracy.
Knowledge of DC Medicaid regulations and MCO policies.
Problem-solving skills for denial resolution.
Ability to manage multiple payers and deadlines
Preferred Qualifications:
Experience with CARF-accredited organizations.
Familiarity with services such as:
Community Support Services (CSS),
Intensive in Home and Community Services(CBI)
Assertive Community Treatment (ACT)
Medication Management
Intensive Care Coordination (ICC)
Certification such as Certified Professional Biller (CPB) is a plus.
- .
Qualifications:
High school diploma required; Associate’s or Bachelor’s degree preferred.
2 years of Medicaid billing experience, preferably in behavioral health or community-based services.
Salary : $25 - $28