This is a remote position.

Mental & Behavioral Health Biller & Credentialing Specialist

About the Role

We are seeking a senior-level Mental & Behavioral Health Biller & Credentialing Specialist who owns the full revenue cycle from provider enrollment to clean claim to payment resolution. This role is critical to ensuring clinicians are credentialed correctly, claims are submitted accurately, denials are prevented (not just fixed), and revenue flows consistently.

This position requires deep experience in mental/behavioral health billing, strong Medicaid and commercial payer knowledge, and proactive collaboration with clinical, HR, and operations teams.

Key Responsibilities

Billing & Revenue Cycle Management

• Submit, track, and resolve claims for mental and behavioral health services including therapy, school-based services, and telehealth
  

• Maintain a high clean-claim rate through accurate CPT coding, modifiers, POS, and provider configuration
  

• Monitor and manage accounts receivable; actively work claims aged 30/60/90+ days
  

• Identify denial trends and implement corrective actions to reduce future denials
  

• Prepare and submit appeals with supporting documentation
  

• Post ERAs and payments accurately; reconcile payer remittances
  

• Verify benefits, eligibility, and authorization requirements as needed
  

• Ensure compliance with Medicaid and commercial payer billing regulations
  

Provider Credentialing & Enrollment

• Manage end-to-end credentialing for therapists and prescribers across payers and states
  

• Complete and maintain CAQH profiles and re-attestations
  

• Submit and track individual and group enrollments
  

• Coordinate site-specific or school-based enrollments when required
  

• Track credentialing timelines and follow up proactively with payers
  

• Manage re-credentialing cycles to prevent lapses in billing eligibility
  

Compliance & Quality

• Ensure billing aligns with clinical documentation, supervision requirements, and payer rules
  

• Identify and flag unbillable or high-risk services before claims submission
  

• Maintain HIPAA compliance in all billing and credentialing activities
  

• Stay current on payer rule changes and regulatory updates
  

Collaboration & Communication

• Work closely with clinicians to resolve documentation or coding issues
  

• Partner with HR/onboarding to ensure credentialing is initiated early
  

• Communicate clearly with clinical leadership regarding revenue risks or delays
  

• Educate providers on common billing and documentation issues when needed
  

Reporting & Performance Metrics

• Provide regular reports on:
  

• Claim volume and denial rates
  

• AR aging
  

• Credentialing status and timelines
  

• Revenue trends and risks
  

• Meet defined benchmarks for clean-claim rate, AR days, and credentialing turnaround
  

Required Qualifications

• 7–10+ years of mental and behavioral health billing experience
  

• Hands-on experience with Medicaid and commercial payers
  

• Strong credentialing experience (CAQH, individual & group enrollments)
  

• Familiarity with mental health CPT codes, modifiers, and POS rules
  

• Experience with EHR/practice management systems and clearinghouses
  

• High attention to detail with strong follow-through
  

• Ability to work independently and manage competing priorities
  

Preferred

• Multi-state billing and credentialing experience
  

• School-based mental health billing experience
  

• Experience scaling billing operations in a growing organization