Medical Billing & Coding Specialist – Detox & Behavioral Health
Facility: Simple & Serene Detox & Recovery
Location: Mesa, Arizona
Employment Type: Full-Time
Work Location: On-Site – Mesa, AZ
Department: Billing & Revenue Cycle
Reports To: Administrator / Operations Director
Position Summary
Simple & Serene Detox & Recovery is seeking an experienced Medical Billing & Coding Specialist with a strong background in behavioral health, substance use disorder treatment, detoxification, or residential treatment billing.
This is an on-site position responsible for supporting the facility's complete revenue-cycle process, including insurance verification, authorizations, coding, claim submission, payment posting, denial management, accounts receivable follow-up, and reconciliation.
The ideal candidate understands that successful behavioral-health billing requires more than submitting claims. This individual must proactively identify authorization, documentation, coding, credentialing, and payer issues before they result in lost revenue.
Essential Duties & ResponsibilitiesMedical Billing & Claims Management
- Prepare and submit accurate insurance claims for detoxification and behavioral health services.
- Review claims for accuracy and completeness prior to submission.
- Ensure claims are submitted to the appropriate payer within required filing deadlines.
- Monitor electronic claim acceptance and rejection reports.
- Correct and resubmit rejected claims promptly.
- Track claims from initial submission through final payment.
- Submit corrected claims, reconsiderations, and appeals when necessary.
- Maintain accurate documentation of all billing activity.
- Identify billing trends that may negatively affect reimbursement.
Behavioral Health & Detox Billing
- Maintain working knowledge of billing requirements applicable to detoxification, withdrawal management, substance use disorder, residential, and behavioral health services.
- Understand payer-specific requirements related to levels of care, authorization, medical necessity, and reimbursement.
- Review clinical documentation to determine whether required documentation is present to support billed services.
- Work collaboratively with clinical, nursing, medical, utilization review, and admissions personnel to resolve documentation deficiencies.
- Communicate recurring documentation issues to leadership.
- Maintain knowledge of applicable CPT, HCPCS, ICD-10-CM, revenue codes, modifiers, and other coding requirements relevant to assigned services.
Insurance Verification & Benefits
- Verify insurance eligibility and benefits prior to or immediately following admission as appropriate.
- Confirm behavioral health and substance use disorder benefits.
- Determine deductibles, copayments, coinsurance, out-of-pocket requirements, and other available benefit information.
- Identify network status and payer requirements.
- Document verification results accurately.
- Communicate relevant financial information to admissions and leadership.
- Reverify benefits when clinically or operationally necessary.
Authorization & Utilization Review Support
- Coordinate closely with admissions and utilization review personnel regarding initial and continued-stay authorization requirements.
- Track authorization numbers, approved dates, levels of care, and authorized units/days.
- Maintain authorization tracking systems.
- Identify authorization expirations before they create billing problems.
- Assist with submission of required payer information when assigned.
- Immediately escalate authorization discrepancies or potential coverage issues.
- Reconcile authorized services against billed services.
Coding & Documentation Review
- Review medical and behavioral health documentation for coding and billing completeness.
- Assign or validate applicable diagnosis and procedure codes consistent with qualifications and assigned responsibilities.
- Identify missing, inconsistent, incomplete, or potentially noncompliant documentation.
- Work with authorized clinical and medical personnel to obtain legitimate documentation corrections when necessary.
- Never alter clinical documentation or direct clinicians to document services that were not actually provided.
- Maintain coding practices consistent with applicable payer and regulatory requirements.
Claims Follow-Up & Accounts Receivable
- Maintain active oversight of outstanding accounts receivable.
- Follow up consistently on unpaid and underpaid claims.
- Contact insurance companies regarding claim status and reimbursement issues.
- Research aged accounts and identify barriers to payment.
- Work denials promptly.
- Track payer correspondence and requests for additional information.
- Escalate significant or recurring reimbursement problems to leadership.
- Maintain organized aging reports.
- Prioritize high-dollar and time-sensitive accounts.
Denials & Appeals
- Review and categorize claim denials.
- Determine appropriate corrective action.
- Correct billing errors and resubmit claims when appropriate.
- Prepare reconsideration and appeal documentation.
- Coordinate with medical and clinical staff when additional supporting documentation is legitimately required.
- Track appeal deadlines and outcomes.
- Analyze denial patterns and recommend corrective action.
- Help reduce preventable denials through front-end process improvement.
Payment Posting & Reconciliation
- Post insurance payments, adjustments, and patient responsibility accurately.
- Review electronic remittance advice and explanation-of-benefit documentation.
- Identify underpayments and incorrect contractual adjustments.
- Reconcile payments against submitted claims.
- Identify discrepancies between expected and actual reimbursement.
- Coordinate with accounting and leadership regarding deposits and reconciliation.
- Maintain accurate patient-account balances.
Credentialing & Payer Support
- Assist leadership and credentialing personnel with payer-related administrative issues as assigned.
- Maintain current payer contact information and billing requirements.
- Help identify credentialing or enrollment issues affecting claims.
- Track payer changes that may impact reimbursement.
- Assist with payer portals and electronic billing systems.
Revenue Cycle Reporting
Provide leadership with regular reporting regarding:
- Claims submitted
- Payments received
- Outstanding accounts receivable
- Aging by payer
- Denial rates
- Rejection rates
- Underpayments
- Authorization issues
- Unbilled accounts
- Billing holds
- Appeal status
- Major payer issues
- Revenue-cycle trends
The Billing Specialist should be able to clearly explain where the facility's money is, what is preventing payment, and what action is being taken to collect it.
Compliance & Confidentiality
- Maintain compliance with HIPAA and applicable substance use disorder confidentiality requirements.
- Protect confidential client, financial, and insurance information.
- Follow applicable federal and state billing requirements.
- Maintain ethical coding and billing practices.
- Never knowingly submit claims for services that were not provided or supported by documentation.
- Report suspected billing, documentation, or compliance concerns to leadership.
- Participate in internal billing audits and corrective-action initiatives.
- Maintain records necessary to support payer audits and reviews.
Required Qualifications
- High school diploma or GED required.
- Minimum 2 years of medical billing experience strongly preferred.
- Previous experience with healthcare insurance claims and revenue-cycle processes.
- Working knowledge of ICD-10-CM, CPT, HCPCS, and healthcare billing terminology.
- Experience with insurance verification, claim submission, denials, appeals, payment posting, and accounts receivable.
- Strong computer and electronic medical record skills.
- Excellent attention to detail.
- Strong organizational and problem-solving abilities.
- Ability to manage multiple payer accounts and deadlines.
- Strong written and verbal communication skills.
- Ability to maintain confidential information.
- Ability to work on-site at our Mesa, Arizona facility.
Strongly Preferred Qualifications
- Behavioral health billing experience.
- Substance use disorder treatment billing experience.
- Detoxification or withdrawal-management billing experience.
- Residential treatment billing experience.
- Experience billing commercial insurance and/or Arizona Medicaid/AHCCCS programs.
- Experience with behavioral health authorizations and utilization review.
- Experience working with behavioral health EMRs and clearinghouses.
- Experience managing behavioral health denials and appeals.
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Biller (CPB), or comparable coding/billing certification.
Knowledge, Skills & Abilities
The successful candidate should have a strong understanding of healthcare revenue-cycle management and be able to work independently without waiting for leadership to discover billing problems.
The individual must be analytical, persistent, organized, deadline-driven, comfortable communicating with insurance companies, and capable of collaborating professionally with admissions, clinical, nursing, medical, and administrative personnel.
Behavioral-health billing experience is highly valued because the position requires understanding the relationship between admission, eligibility, authorization, medical necessity, documentation, coding, claim submission, and reimbursement.
Schedule
Full-Time | On-Site
Monday–Friday | Day Shift
This is not a remote position. The Medical Billing & Coding Specialist will work from the Simple & Serene Detox & Recovery facility in Mesa, Arizona and collaborate directly with admissions, clinical, nursing, utilization review, and administrative leadership.
Performance Expectations
Success in this position will include timely clean-claim submission, aggressive but appropriate AR follow-up, accurate coding, reduced preventable denials, timely appeals, accurate payment posting, identification of underpayments, strong authorization tracking, low unbilled-account volume, accurate reporting, and consistent communication with leadership regarding revenue-cycle risks.
Our Mission
At Simple & Serene Detox & Recovery, our mission is to provide a safe, compassionate, and peaceful environment where individuals can stabilize, heal, and begin building a foundation for lasting recovery.
Strong clinical care requires strong operations. Our Medical Billing & Coding Specialist plays a critical role in protecting the financial health of the organization so our team can continue providing high-quality treatment to individuals and families affected by addiction.
Simple & Serene Detox & Recovery is an Equal Opportunity Employer.
Pay: From $30.00 per hour
Work Location: In person
