Insurance Billing Specialist

Summary

Contract Revenue Cycle Biller

Contract Position | Remote | Behavioral Health Revenue Cycle (RTC, PHP, and IOP)

Overview

The Hope Group operates multiple behavioral health care businesses, serving more than 100 clients at any given time. We are seeking a highly competent Contract Revenue Cycle Biller to manage billing and accounts receivable for approximately 20 active clients.

Most client funding comes from commercial insurance. However, some clients may be funded through school districts, state agencies, private pay arrangements, or other contracted funding sources. This role is responsible for making sure each funding source is billed accurately, invoices and claims are submitted on time, and payments are collected and properly recorded.

This position is critical to maintaining financial health and preventing administrative issues from disrupting client care. The ideal candidate has strong behavioral health billing experience, is highly organized and proactive, and can independently manage accounts from initial authorization or funding verification through final payment.

Primary Responsibilities

Insurance Billing and Claims Management

• Submit accurate and timely insurance claims for RTC, PHP, and IOP services
• Ensure proper coding, modifiers, rates, and documentation alignment before submission
• Monitor claim status and proactively resolve denials, rejections, and underpayments
• Track claims through full payment resolution
• Maintain clean and organized billing records for all clients

School District, State, and Private Pay Billing

• Prepare and submit invoices to school districts, state agencies, families, and other funding partners
• Confirm billing rates, service dates, purchase orders, contracts, and supporting documentation
• Track invoices from submission through payment
• Follow up on overdue balances and resolve missing documentation or payment issues
• Maintain clear records of payer requirements, billing contacts, and payment terms

Utilization Review and Authorizations

• Obtain and manage pre-authorizations for covered services
• Submit concurrent and continued-stay reviews to insurance companies
• Track authorization dates, units, service limits, and expiration timelines
• Coordinate with clinical staff to obtain necessary documentation
• Help verify that services remain aligned with payer and funding requirements

Accounts Receivable Management

• Perform ongoing follow-up with insurance companies and other funding sources
• Identify and escalate billing issues early to prevent aging balances
• Maintain low accounts receivable aging through proactive management
• Reconcile payments, adjustments, EOBs, remittance notices, and outstanding balances
• Ensure all accounts have a clear next action and expected payment timeline

Insurance Paneling and Credentialing Support

• Assist with insurance paneling applications and renewals
• Maintain credentialing records and documentation
• Track panel status and help ensure continuity of network participation

Coordination, Tracking, and Communication

• Communicate clearly with leadership regarding billing status, collection risks, and unresolved issues
• Collaborate with clinical and operational staff to ensure documentation supports billing requirements
• Maintain accurate tracking by client, payer, funding source, invoice, claim, and payment status
• Provide regular reporting on billing performance, outstanding balances, aging, denials, and risks

Expected Scope

• Approximately 20 active clients
• Primarily commercial insurance billing
• Additional billing to school districts, state agencies, private pay families, and other funding sources
• Primarily RTC, with some PHP and IOP services
• Ongoing monthly billing, follow-up, utilization management, invoicing, and collections
• Flexible hours, with consistent weekly engagement required

Required Qualifications

• Minimum two years of behavioral health billing or revenue cycle experience
• RTC billing experience strongly preferred
• Proven experience working with commercial insurance providers
• Strong experience with pre-authorizations, utilization review, and denial resolution
• Experience managing claims or invoices through the full lifecycle, from submission through payment
• Experience managing accounts receivable and following up on aging balances

Technical Skills

• Strong understanding of behavioral health billing workflows
• Knowledge of CPT, HCPCS, revenue codes, modifiers, and payer-specific billing requirements
• Familiarity with insurance portals, clearinghouses, claims systems, and invoicing tools
• Ability to manage multiple funding structures, rates, contracts, and payment terms
• Strong organizational, reconciliation, and tracking skills

Personal Attributes

• Highly detail-oriented
• Proactive and responsive
• Strong ownership mentality
• Persistent and professional in payment follow-up
• Able to work independently with minimal supervision
• Clear and professional communicator

Preferred Qualifications

• Experience billing school districts, state agencies, Medicaid programs, or government contracts
• Experience with private pay invoicing and collections
• Experience billing for transitional living or outpatient behavioral health programs
• Experience with credentialing and insurance paneling
• Familiarity with the Utah behavioral health funding and insurance landscape
• Experience working in contract or outsourced billing roles

Position Details

• Contract position (1099)
• Remote work
• Flexible hours

Success in This Role Looks Like

• Claims and invoices submitted accurately and on time
• Authorizations obtained without interruption to care
• Minimal claim denials and fast resolution when denials occur
• School district, state, and private pay invoices collected within agreed payment terms
• Low accounts receivable aging across all funding sources
• Every outstanding balance has a documented next action
• Leadership has clear visibility into billing, collections, and payment risks at all times