Overview:
We are seeking an experienced Behavioral Health / Substance Use Disorder (SUD) Medical Billing Specialist to support the billing and revenue cycle operations of a growing behavioral healthcare organization. The ideal candidate has hands-on experience with Behavioral Health and/or SUD billing, strong knowledge of Maryland Medicaid, and experience working with CollabMD or a similar behavioral health billing platform. This role will be responsible for managing billing activities from insurance verification and authorization through claims submission, denial resolution, and accounts receivable follow-up.
Work Setup:
- Remote
- Full-Time
- Monday–Friday, U.S. Eastern Time
Key Responsibilities:
Insurance Verification & Eligibility
- Verify patient insurance eligibility and behavioral health/SUD benefits.
- Confirm coverage, benefits, payer requirements, and authorization requirements.
- Identify potential insurance issues before services are billed.
Authorization & Renewals
- Process and track prior authorizations for behavioral health and SUD services.
- Monitor authorization numbers, approved units, service dates, and expiration dates.
- Coordinate authorization renewals and additional units as needed.
- Follow up with payers regarding pending or incomplete authorizations.
Claims Submission
- Prepare and submit accurate claims for behavioral health and SUD services.
- Ensure claims contain accurate patient, provider, diagnosis, CPT/HCPCS, modifier, authorization, and payer information.
- Monitor claim status and follow up on rejected or unpaid claims.
Maryland Medicaid Billing
- Process claims for Maryland Medicaid.
- Understand Maryland Medicaid billing requirements and payer-specific procedures.
- Research and resolve Maryland Medicaid claim issues, rejections, and denials.
Denial Management
- Review denied and rejected claims to determine the root cause.
- Correct errors and resubmit claims when appropriate.
- Assist with reconsiderations and appeals.
- Identify recurring denial trends and proactively recommend solutions
Accounts Receivable
- Monitor outstanding insurance claims and balances.
- Conduct timely A/R follow-up with insurance companies.
- Research aging claims, underpayments, and unpaid balances.
- Maintain accurate documentation of payer communications and follow-up activities.
Billing System Management
- Maintain accurate billing information within CollabMD.
- Ensure patient, payer, authorization, and claim information is accurately documented.
- Maintain organized records and billing workflows.
Required Qualifications:
- 2+ years of hands-on medical billing experience
- Behavioral Health and/or SUD billing experience – required
- Maryland Medicaid billing experience – required
- CollabMD experience – required or strongly preferred
- Experience with insurance verification and eligibility
- Prior authorization experience
- Claims submission and follow-up experience
- Denial management and appeals experience
- A/R and insurance collections experience
- Strong understanding of U.S. healthcare insurance processes
- Excellent attention to detail and follow-through
- Ability to work independently and manage multiple priorities
- Strong written and verbal communication skills
- Ability to work U.S. Eastern Time hours
Non-Negotiables:
The ideal candidate must have:
- Behavioral Health / SUD medical billing experience
- Maryland Medicaid billing experience
- Hands-on experience with CollabMD
- Strong claims, denial, and A/R experience
- Prior authorization and renewal experience
- Experience working with U.S. healthcare payers
Success Measures:
Within the first 30–60 days, the successful candidate should:
- Independently manage assigned behavioral health/SUD billing responsibilities.
- Submit accurate claims within payer deadlines.
- Proactively follow up on unpaid and aging claims.
- Reduce avoidable claim denials and rejections.
- Maintain accurate authorization and renewal tracking.
- Demonstrate strong knowledge of Maryland Medicaid billing requirements.
- Keep billing records and CollabMD information accurate and up to date.
- Escalate issues proactively and recommend solutions rather than simply identifying problems.
- Reduce the day-to-day billing workload for the client’s billing management team.
