Billing Specialist

Overview

The Prior Authorization & Billing Specialist plays a critical role in ensuring timely access to mental health services by managing insurance authorizations, billing processes, and reimbursement workflows. This position serves as a key liaison between clinical teams, insurance payers, and patients, ensuring services are authorized, accurately billed, and compliant with regulatory and payer requirements. This role is ideal for a detail-oriented professional passionate about supporting behavioral health access through strong administrative and revenue cycle expertise.

• Obtain and manage prior authorizations for outpatient and inpatient mental health services, including therapy, psychiatry, psychological testing, and intensive programs.
• Review clinical documentation to ensure medical necessity and payer compliance.
• Submit authorization requests to insurance companies via portals, phone, or electronic systems.
• Track authorization approvals, denials, expirations, and extensions; proactively follow up to prevent treatment delays.
• Communicate authorization status clearly with clinicians, scheduling staff, and leadership.
• Assist with peer-to-peer reviews and appeals when authorization is denied or partially approved.
• Submit accurate and timely claims for mental health services to commercial, Medicaid, and Medicare payers.
• Verify insurance eligibility, benefits, and coverage limitations prior to services.
• Review Explanation of Benefits (EOBs) and remittance advice for accuracy.
• Identify, research, and resolve claim denials, underpayments, and rejections.
• Post payments and adjustments accurately when applicable.
• Maintain compliance with CPT, ICD-10, and modifier guidelines specific to behavioral health billing.

• Maintain accurate patient authorization and billing records within electronic health record (EHR) and billing systems.
• Ensure compliance with HIPAA, payer contracts, and internal policies.
• Collaborate with clinical, administrative, and finance teams to optimize workflows and reduce revenue leakage.
• Monitor payer requirements, policy changes, and authorization rules related to mental health services.
• Prepare reports related to authorization turnaround times, denial trends, and billing performance.
• Perform other related duties as assigned.

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or related field preferred.
• Minimum of 2 years of experience in prior authorization, utilization review, medical billing, or revenue cycle operations.
• Experience in mental health or behavioral health services strongly preferred.

• Strong understanding of prior authorization processes and insurance requirements.
• Knowledge of behavioral health billing practices, CPT and ICD-10 coding, and payer guidelines.
• Excellent attention to detail and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong written and verbal communication skills, including professional interaction with payers and clinical staff.
• Ability to work independently while collaborating effectively with a team.
• Proficiency with EHR systems, billing software, and Microsoft Office applications.