Billing Specialist

Department: Billing
Employment Status: Full-Time
Reports To: Chief Operations Officer

Position Summary

The Behavioral Health Billing Specialist is responsible for accurately processing and monitoring claims for behavioral health services. This position works closely with clinical staff, insurance companies, clients, and other departments to ensure services are properly documented, billed, and reimbursed.

The Behavioral Health Billing Specialist must demonstrate attention to detail, confidentiality, professionalism, and knowledge of healthcare billing requirements. This position supports the financial operations of Lewis & Clark Behavioral Health Services while helping ensure clients receive accurate and timely information regarding their insurance coverage and accounts.

Essential Duties and Responsibilities

• Submit claims to Medicaid, Medicare, commercial insurance companies, and other funding sources.
• Verify client insurance eligibility, coverage, benefits, authorizations, and service limitations.
• Ensure claims include the correct client information, provider, program, service location, diagnosis code, CPT code, modifier, and units of service.
• Enter and maintain accurate billing information in the electronic health record and billing systems.
• Review rejected and denied claims, identify the cause, make necessary corrections, and resubmit claims promptly.
• Monitor unpaid claims and follow up with insurance companies regarding outstanding balances.
• Complete timely follow-up on accounts receivable and document all collection efforts.
• Review explanation of benefits and electronic remittance advice for correct payment and adjustment information.
• Post insurance payments, adjustments, denials, and client payments accurately.
• Identify recurring billing problems and report trends to the appropriate supervisor.
• Communicate with clinical staff regarding missing, incomplete, or inconsistent documentation.
• Communicate professionally with clients regarding insurance coverage, statements, balances, and payment questions.
• Maintain accurate and organized billing records.
• Prepare billing, denial, accounts receivable, and productivity reports as requested.
• Assist with audits and quality-assurance reviews.
• Follow established billing procedures, payer requirements, organizational policies, and applicable state and federal regulations.
• Maintain the confidentiality of client and organizational information in accordance with HIPAA and other privacy requirements.
• Stay informed of changes to insurance requirements, billing regulations, and organizational procedures.
• Meet established deadlines and productivity expectations.
• Participate in departmental meetings, training, and process-improvement activities.
• Provide billing coverage and assistance to other team members as needed.

Perform other duties as assigned.

Required Qualifications

• High school diploma or equivalent.
• Previous experience in medical billing, healthcare billing, insurance processing, accounts receivable, or a related position.
• General knowledge of healthcare claims, insurance terminology, and reimbursement processes.
• Ability to maintain confidentiality and handle sensitive client information appropriately.
• Strong attention to detail and commitment to accuracy.
• Ability to organize work, manage multiple priorities, and meet deadlines.
• Effective written and verbal communication skills.
• Ability to work independently and collaboratively as part of a team.
• Basic proficiency with computers, email, electronic records, and Microsoft Office applications.
• Ability to maintain consistent and reliable attendance.

Preferred Qualifications

• Associate degree or certification in medical billing, health information management, business, accounting, or a related field.
• Experience with mental health, behavioral health, or substance use disorder billing.
• Experience billing Medicaid, Medicare, and commercial insurance plans.
• Knowledge of CPT codes, ICD-10 diagnosis codes, modifiers, authorizations, and timely filing requirements.
• Experience using SmartCare or another electronic health record and billing system.
• Experience reviewing denials, submitting corrected claims, and following up on accounts receivable.

Knowledge, Skills, and Abilities

The successful candidate should demonstrate:

• Accuracy and attention to detail.
• Strong organizational and time-management skills.
• Sound judgment and problem-solving abilities.
• Professional and respectful communication.
• Dependability and accountability.
• Ability to understand and follow detailed billing requirements.
• Ability to identify errors and take appropriate corrective action.
• Ability to work with clients, providers, coworkers, and insurance representatives.
• Willingness to learn new systems and adapt to changing payer requirements.
• Commitment to the mission and values of Lewis & Clark Behavioral Health Services.

Working Conditions

This position is primarily performed in an office environment and requires regular use of a computer, telephone, electronic health record, and other standard office equipment. The employee may spend extended periods sitting, reviewing detailed information, and completing computer-based tasks.

Physical Requirements

The employee must be able to perform the essential duties of the position with or without reasonable accommodation. The position may require prolonged sitting, frequent computer use, occasional standing or walking, and lifting or carrying standard office materials.

LCBHS offers an excellent benefits package!

Three weeks paid vacation per year, 10 paid holidays, paid sick leave, paid individual employee health insurance, life insurance, available vision and dental insurance, dependent care savings, health care savings, 401K with up to 6 percent employer match - 100% vested upon enrollment, potential student loan repayment and more!