Behavioral Health Billing Specialist

Harper Clinic (Outpatient Clinic in Orem) and Maple Mountain Mental Health and Wellness (16 bed adult residential treatment facility) are sister organizations providing integrated Behavioral Health and Substance Use Disorder care in Utah County. We're looking for a detail oriented Billing & UR Specialist to support both organizations.

• Conduct utilization reviews for residential and PHP level of care
• Coordinate with insurance payers on continued stay authorizations
• Maintain documentation to support medical necessity

• Obtain and track prior authorizations for IOP and TMS services
• Communicate authorization status to clinical and front office staff

• Submit outpatient claims accurately and on time (nearly automated with our EHR)
• Manage claim denials, appeals, and resubmissions
• Record ERAs (Electronic Remittance Advice) in the EHR (nearly automated, just audit for accuracy)
• Serve as a point of contact for patients with billing questions or concerns, communicating clearly and with empathy

• Billing & Coding Certification
• Prior experience in utilization review
• Prior experience in medical and behavioral health billing (claims submission, denial management, ERA posting)
• Comfortable working across two small organizations and multiple service lines
• Strong communicator, comfortable speaking directly with patients about billing
• Organized and able to manage a varied workload with shifting priorities (ie: one week may be UR heavy with minimal outpatient denials, the next week may be low UR's but sudden denial management concerns)

• Must pass a background check and drug screen
• Full time, on site in North Orem, UT (hybrid may be considered after 6 months, based on performance)

DOE (depends on experience)

PTO, Health Benefits, and 401k available