Internal Billing & Revenue Cycle Specialist

Position Summary

A Mental Health client is seeking an experienced, highly organized, and patient-focused Internal Billing & Revenue Cycle Specialist to own the practice's full-cycle revenue cycle management, front to back. This role is responsible for the complete billing lifecycle — charge capture and check-in, claim submission, payment posting, denial management, AR follow-up, and patient collections — and serves as the primary point of contact for both patients and insurance payers.

This is a behavioral health practice, and behavioral health billing knowledge is a true must-have: behavioral health uses coding and payer processes that are materially different from general medical or family practice billing, and the ideal candidate is already fluent in them. The practice is also newly credentialing with Medicare (with Medicare Advantage/commercial credentialing underway) and does not yet have in-house Medicare expertise — this person must be able to work Medicare Part B claims independently from day one, without an internal mentor to lean on.

The ideal candidate is comfortable working both behind the scenes on billing operations and directly with patients and families to provide exceptional, compassionate customer service, and will collaborate closely with the Practice Manager and CEO (Dr. Bryant), who runs a weekly billing meeting and expects clear, accurate reporting.

Essential Duties and Responsibilities

Revenue Cycle (Full Cycle, Front to Back)

• Own the full revenue cycle for the practice, front and back office — charge entry, check-in, claim creation, claim submission, payment posting, and AR workflows.
• Review claims for accuracy and identify billing issues prior to submission.
• Investigate and resolve claim rejections, denials, and underpayments; submit corrected claims and appeals as necessary.
• Review and work accounts receivable aging reports to ensure timely reimbursement.
• Serve as the primary point of contact for both patients and insurance payers — no external billing vendor hand-off.

Patient Billing & Collections

• Manage patient balances and collection activities in accordance with practice policies.
• Contact patients regarding outstanding balances and establish payment arrangements when appropriate.
• Process patient payments and maintain accurate, transparent account balances — no undisclosed charges or retroactive corrections to prior months' billing.
• Reconcile payment discrepancies and research billing concerns.
• Maintain accurate financial documentation and patient account records.

Patient Financial Services & Customer Support

• Serve as the primary contact for the practice's billing phone line.
• Answer patient questions regarding deductibles, copayments, coinsurance, eligibility/benefits, outstanding balances, payment arrangements, and billing statements/charges.
• Provide patients with copies of billing statements, itemized receipts, and payment histories upon request.
• Explain billing information clearly, professionally, and compassionately to patients and families.
• Resolve patient billing concerns promptly and escalate complex issues when necessary.
• Exceptional phone etiquette and customer service are required — the practice has had prior issues with unprofessional patient interactions, and this is a key hiring priority.

Reporting & Performance Monitoring

• Monitor and report on key revenue cycle metrics to management, including Days in AR, AR Aging, Clean Claim Rate, Claim Creation/Submission Lag, Payment Posting Timeliness, and Patient Collection Performance.
• Prepare and present clear reports for the CEO's weekly billing meeting; strong working proficiency in Excel and PowerPoint is required to build these reports independently.

Compliance & Collaboration

• Maintain compliance with HIPAA, payer guidelines, and all applicable federal and state regulations. Candidate must hold a current HIPAA certification.
• Ensure billing documentation supports medical necessity and payer requirements.
• Collaborate effectively with the Practice Manager, administrative staff, and CEO to resolve billing-related concerns and improve operational processes.

Qualifications

2+ years medical billing / revenue cycle experience, with dedicated behavioral health billing experience — a hard requirement, not a preference

• Direct, hands-on Medicare billing experience, ideally Medicare Part B, and the ability to work claims independently with no internal mentor

• Current HIPAA certification

• Comprehensive knowledge of the full billing lifecycle: claims management, payment posting, denials, collections, and AR
• Strong understanding of behavioral health CPT coding, ICD-10 coding, insurance terminology, and payer guidelines
• Exceptional customer service and phone/communication skills; professional and compassionate with financial conversations
• Strong analytical, organizational, and problem-solving skills; comfortable owning the full cycle independently
• Working proficiency in Excel and PowerPoint, sufficient to build AR aging, clean claim rate, and denial trend reports

• Experience with eClinicalWorks (eCW) or a comparable EHR/EMR

• Experience with Medicaid billing

• Experience with EAP insurances, particularly Lyra and ComPsych (training provided if needed)

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Originally posted on Himalayas