Medical Biller / Coder

Job Summary

The Internal Biller is responsible for accurately preparing, submitting, and tracking billing across multiple payer types, including PIHP/CMH, commercial insurance, and self‑pay. This role ensures compliance with state, payer, and behavioral health coding standards. The Internal Biller works closely with clinical, administrative, and finance teams to support timely and accurate reimbursement and maintain the integrity of the organization’s revenue cycle.

Key Responsibilities

· Prepare, process, and submit billing to PIHP/CMH entities according to contractual requirements.

· Ensure claims align with authorized services, service notes, encounter reporting standards, and Medicaid guidelines.

· Monitor outstanding PIHP claims and resolve denials, rejections, or payment discrepancies.

· Maintain updated knowledge of PIHP-specific billing rules, encounter codes, and rate changes.

· Reconcile PIHP remittance advice and verify proper payment posting.

· Prepare and submit claims to commercial insurance payers electronically and manually.

· Verify client insurance eligibility, coverage, and benefit limitations as needed.

· Review claims for accuracy and ensure correct coding, modifiers, NPI usage, and documentation requirements.

· Follow up on unpaid or underpaid claims and manage payer correspondence.

· Assist with resolving complex claim issues and payer escalations.

· Patient balance billing and collections.

· Apply correct BH procedure codes, diagnostic codes, and payer‑specific billing rules.

· Ensure clinical documentation supports billed services and meets regulatory standards.

· Create and issue invoices for BH services, including grant‑funded programs.

· Audit provider notes, billing codes, and encounter data to ensure billing accuracy and compliance.

· Maintain coding knowledge according to updates to BH billing regulations.

Qualifications

· High school diploma or equivalent.

· 2 years of billing experience in behavioral health, healthcare, or human services.

· Experience with PIHP/CMH billing, commercial insurance billing, and BH coding.

· Understanding of payer rules, encounter codes, and Medicaid/Medicare billing

standards.

· Proficiency in EHR systems, billing software, and Microsoft Office.

· Strong accuracy, attention to detail, and ability to manage multiple priorities.

· Associate or Bachelor’s degree in a related field.

· Experience working in a behavioral health or SUD setting.

· Familiarity with CPT/HCPCS coding, DSM/ICD standards, and Medicaid PIHP structures.

· Knowledge of HIPAA and 42 CFR Part 2 compliance requirements.

Core Competencies

· Billing and coding accuracy

· Regulatory compliance awareness

· Problem‑solving and analytical skills

· Communication and collaboration

· Time management and organization

· Confidentiality and professionalism

Job Type: Full-time

Pay: $19.50 - $25.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Vision insurance

People with a criminal record are encouraged to apply

Experience:

• Medical billing: 2 years (Preferred)
• Medical coding: 2 years (Preferred)

Work Location: In person

Salary : $20 - $25