Billing/Credentialing Specialist
Job Title: Billing and Crediting Specialist
Position Summary
The Billing and Credentialing Specialist supports the financial operations by accurately billing for behavioral health services, processing approved credits and account adjustments, and maintaining client account records. This position works closely with clinical staff, administrative personnel, insurance companies, and clients to resolve billing concerns and support timely reimbursement.
Essential Duties and Responsibilities
Prepare and submit claims and invoices for services provided, including electronic insurance claims and client statements.
Verify client demographic information, insurance eligibility, benefits, and coverage details before billing.
Review service records for billing completeness, including dates of service, provider information, authorizations, and required supporting documentation.
Coordinate with LPCs, QMHPs, and other service providers to resolve missing or inconsistent billing information.
Confirm billed services align with documented services, approved authorizations, and payer requirements.
Monitor outstanding claims and follow up on unpaid, rejected, or denied claims.
Research billing discrepancies and prepare corrected claims or assist with appeals as appropriate.
Post insurance payments and client payments accurately and reconcile them with remittance information.
Review contractual adjustments and process approved credits, refunds, and other account corrections.
Identify potential overpayments, duplicate payments, and incorrect balances and escalate them for review.
Respond professionally to client questions about statements, payments, insurance coverage, and account balances.
Maintain accurate records of billing activity, payer communications, adjustments, and follow-up actions.
Prepare reports on outstanding balances, denials, payment activity, and unresolved billing issues.
Support month-end reconciliation and provide documentation for audits and internal reviews.
Protect confidential client information and follow HIPAA requirements and organizational privacy policies.
Identify recurring billing issues and recommend improvements to strengthen accuracy and reimbursement.
Perform other related duties as assigned.
Qualifications
High school diploma or equivalent required; an associate degree in healthcare administration, accounting, business, or a related field preferred.
One to three years of experience in medical billing, behavioral health billing, accounts receivable, or a related role preferred.
Familiarity with commercial insurance and Medicaid billing processes, as applicable to the organization’s services.
Working knowledge of medical billing terminology, CPT/HCPCS codes, ICD-10 diagnosis codes, and insurance remittance statements.
Experience with electronic health records, practice management systems, billing software, and Microsoft Excel.
Understanding of client confidentiality and HIPAA requirements.
Strong attention to detail, organizational skills, and ability to meet billing deadlines.
Effective communication skills and a professional, respectful approach to sensitive financial conversations.
Ability to investigate discrepancies and coordinate solutions with clinical and administrative teams.
Core Competencies
Billing accuracy and account reconciliation.
Claims follow-up and denial resolution.
Confidentiality and professional judgment.
Client service and clear communication.
Time management and teamwork.
Work Environment and Physical Requirements
This position primarily works in an office setting and involves extended computer use, telephone communication, and review of electronic records. The employee must be able to perform the essential duties of the position with or without reasonable accommodation.