Billing Cycle Specialist; Mental Health

The Billing Cycle Specialist is responsible for managing the complete revenue cycle for mental health services, from patient intake and insurance verification through claims submission, payment posting, denial management, and collections. This role ensures accurate, timely reimbursement while maintaining compliance with federal, state, and payer-specific regulations. The ideal candidate has experience in behavioral health billing, strong attention to detail, and the ability to collaborate with clinical and administrative teams to optimize revenue performance.

Verify patient insurance eligibility, benefits, authorizations, and coverage for mental health services (individual therapy, group therapy, psychiatry, medication management, IOP/PHP, telehealth, etc.).

Obtain and track prior authorizations and referrals as required by payers.

Ensure accurate patient demographics, payer information, and consent documentation at intake.

Educate patients on financial responsibility, copays, deductibles, and self-pay options.

Review clinical documentation to ensure accuracy and completeness for billing purposes.

Apply correct CPT, HCPCS, and ICD-10 codes specific to mental and behavioral health services.

Ensure compliance with payer guidelines, medical necessity requirements, and documentation standards.

Collaborate with clinicians to resolve documentation or coding discrepancies.

Submit clean claims electronically and/or manually to commercial insurance, Medicaid, Medicare, and managed care plans.

Monitor claim status and proactively follow up on unpaid, pending, or rejected claims.

Correct claim errors and resubmit claims in a timely manner to meet payer filing deadlines.

Maintain accurate billing records within the EHR/practice management system.

Post insurance payments, patient payments, adjustments, and contractual allowances accurately.

Reconcile Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERA).

Identify and report underpayments, over payments, and discrepancies.

Process refunds and payment corrections in accordance with policy.

Analyze claim denials to identify root causes and trends.

Prepare and submit appeals with supporting clinical and billing documentation.

Track appeal outcomes and escalate unresolved issues as needed.

Partner with leadership to implement corrective actions to reduce future denials.

Manage assigned accounts receivable (A/R) and maintain aging within organizational benchmarks.

Conduct patient billing, statements, and follow-up on outstanding balances.

Communicate professionally and compassionately with patients regarding billing questions and payment plans.

Ensure compliance with state and federal collection regulations.

Maintain compliance with HIPAA, CMS guidelines, state regulations, and payer contracts.

Support audits by providing billing records and documentation as requested.

Generate billing, A/R, and revenue reports for leadership review.

Participate in process improvement initiatives to enhance billing accuracy and efficiency.

High school diploma or equivalent required;
Associate’s degree preferred.

2+ years of billing or revenue cycle experience, preferably in mental health, behavioral health, or healthcare.

Working knowledge of CPT, ICD-10, and payer billing rules for mental health services.

Experience billing commercial insurance, Medicaid, Medicare, and managed care plans.

Proficiency with EHR and practice management systems.

Strong attention to detail, organization, and time management skills.

Excellent written and verbal communication skills.

Experience billing outpatient mental health, psychiatry, or substance use disorder services.

Familiarity with telehealth billing regulations.

Knowledge of value-based care or capitated payment models (preferred but not required).

Certification in medical billing or coding (CPB, CPC, CCS, or similar).

Bilingual (Spanish or other languages) preferred.

Outpatient clinic, community mental health center, or hybrid/remote environment (role-dependent).

Full-time, Monday–Friday schedule (may vary based on operational needs).

Collaborative, mission-driven healthcare setting focused on patient-centered care.