Billing and Credentialing Specialist

Job Title: Billing and Credentialing Specialist

Job Classification: Non-Exempt

Supervisor: Director of Business Operations

Location: Virginia, MN

Pay band/Wage Range: $22.00 - $35.35 (Pay band 4) BOE

Benefits: Including but not limited to: Medical, Dental, Life, 401k, PTO, MNPFML

About Our Workplace:

Range Mental Health Center is proud to be a Certified Community Behavioral Health Clinic (CCBHC). The goals of the Certified Community Behavioral Health Clinics program in MN are to 1) increase access to community-based mental health and substance use disorder services (particularly to under-served communities), 2) advance integration of behavioral health with physical health care, and 3) improve utilization of evidence-based practices on a more consistent basis.

As part of our commitment to supporting employees in their professional development, we offer 100% employer provided clinical supervision at no cost to staff in therapy positions or any role requiring clinical licensure. This includes weekly supervision in accordance with all licensing board requirements. Our structure also includes weekly multidisciplinary team meetings and monthly staff meetings. This reflects our broader philosophy of integrated treatment coordination and robust clinical support. Join a team where collaboration, professional development, and integrated care are built into the way we work, every single week.

Job Summary:

The Billing and Credentialing Specialist is responsible for accurate and timely billing, claims processing, payment posting, accounts receivable support, and credentialing RMHC providers. This position ensures compliance with applicable payer, regulatory, and organizational requirements while supporting RMHC’s mission to provide accessible, high-quality behavioral health care.

Duties/Responsibilities:

• Process claims include electronic billing, paper claims, and resubmissions.
• Determine and process adjustments to accounts of the people we serve.
• Process payments, including daily cash receipt register, application of payments to people’s accounts, and account transfers.
• Handle billing inquiries via phone and in person.
• Verify insurance eligibility, benefits, authorizations, and coverage prior to billing when appropriate.
• Complete collection process according to collection policies.
• Monitor claim status and resolve claim rejections, denials, and payment discrepancies promptly.
• Maintain accurate billing records within the Electronic Health Record and billing systems.
• Assist with billing audits, compliance reviews, and financial reports as requested.
• Coordinate with other departments to facilitate and disseminate information relevant for claims processing and payment.
• Follow all Federal guidelines in accordance with the Department of Labor’s statutes and laws and any other regulatory agencies.
• Support RMHC providers application for credentialing by means of obtaining, forwarding, receiving, and submitting the necessary documentation.
• Monitor credentialing status of RMHC providers and advise as needed of any required updates to maintain appropriate credentialing.
• Liaison with all relevant internal and parties to coordinate the entire credentialing process; act as an internal resource to RMHC staff regarding credentialing requirements and appropriate level of provider.
• All other duties as assigned.

Required Skills/Abilities:

• Ability to organize and prioritize tasks
• Ability to maintain confidentiality
• Flexibility to meet demands in a fluid and changing environment
• Assertiveness is sufficient to complete essential functions
• Ability to work independently with minimal direction and as part of a team
• Ability to identify problems and possible solutions and make recommendations
• Ability to exercise sound judgment in the performance of essential functions
• Ability to accurately process numerical and statistical information
• Knowledge of Medicaid, Medicare, managed care organizations, commercial insurance, and behavioral health billing requirements.
• Ability to effectively communicate with co-workers, the people we serve and outside parties
• Ability to operate various Microsoft applications such as Excel, Word, and PowerPoint
• Experience with Electronic Health Record, billing, and claims submission systems.
• Ability to interpret insurance policies, payer requirements, and reimbursement guidelines.
• Ability to run queries, develop data displays, and present data in a meaningful manner
• Regular and reliable attendance is a requirement to this position

Education and Experience:

• Two-year degree is preferred; a High School Diploma or equivalency required.
• Minimum of two years of medical billing experience preferred, preferably in behavioral health or community mental health.
• Philosophical approach consistent with Range Mental Health Center’s mission.
• Experience in insurance, medical billing, and credentialing is preferred.
• Certified Professional Biller or similar credential preferred.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift to 15 pounds at times.
• Ability to operate a keyboard.
• Adequate level of vision to use computer terminal.
• Sufficient hearing to accurately record information received verbally and respond to another party both in person, on the phone, and in a group setting.
• Must be 18 years of age.
• Must be able to maintain a Minnesota driver's license and auto insurance

EOE/AA