Billing & Credentialing Specialist

Canopy Roots•Minneapolis, MN

1d•Hybrid

About The Position

Canopy Roots + Canopy Mental Health & Consulting is seeking a Billing & Credentialing Specialist to lead end-to-end billing operations and own provider credentialing across behavioral health programs. This role focuses on Minnesota Medicaid (MHCP), Medicare, and commercial payer requirements, ensuring healthy revenue cycles, compliant billing, and accurate payer relationships. The specialist will collaborate with finance, clinical, and People Ops teams to manage accounts receivable, payer relationships, billing compliance, and client support.

Requirements

High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
5+ years of experience in behavioral health billing and credentialing.
At least 2 years of behavioral health credentialing experience.
Candidates must be authorized to work in the United States. Sponsorship is not available for this position.
Demonstrated experience with MHCP (Medicaid) billing and requirements.
Demonstrated experience with Medicare credentialing and enrollment.
Demonstrated experience with Commercial payer credentialing.
Strong knowledge of CPT and ICD-10 coding (behavioral health).
Strong knowledge of claims lifecycle, denials management, and appeals.
Experience with EHR billing systems and payer portals (CAQH required).
Proven ability to manage and reduce AR aging.
Strong attention to detail, organization, and ability to manage multiple priorities.
Excellent communication skills with a client-centered, compassionate approach.
Must maintain a secure and private remote work environment with reliable internet access.

Nice To Haves

Experience with Procentive or similar behavioral health EHR systems.
Experience with Minnesota-specific behavioral health programs/services.
Familiarity with authorization workflows and utilization tracking.
Experience preparing for audits or managing compliance reviews.
Experience with fee schedule negotiation or payer contract management.
Strong reporting and data analysis skills (AR dashboards, KPIs).
Experience handling protected health information (PHI) in compliance with HIPAA privacy and security standards.

Responsibilities

Manage full-cycle billing for mental health services, including claim submission, payment posting, and reconciliation.
Verify eligibility and benefits, obtain prior authorizations, and ensure accurate and timely claim submission.
Audit claims against clinical documentation to ensure compliance with CPT/ICD-10 behavioral health coding standards.
Conduct denial management, including research, corrected claims, and appeals with supporting clinical documentation.
Maintain compliance with payer-specific rules, including MHCP (Minnesota Medicaid), Medicare, and commercial payers.
Demonstrate strong working knowledge of MHCP billing requirements, including covered services, modifiers, documentation standards, and authorization rules.
Ensure compliance with state-specific requirements such as interpreter service obligations and provider responsibilities.
Stay current on Minnesota and federal regulatory updates impacting behavioral health billing.
Monitor AR aging and proactively pursue collections through payer and client follow-up.
Partner with finance to prioritize AR recovery and support cash flow planning.
Track and report KPIs such as days in AR, denial rates, and net collection rate.
Recommend and implement process improvements to reduce denials and improve reimbursement timelines.
Manage end-to-end credentialing and re-credentialing for providers across Medicaid (including MHCP), Medicare, and Commercial payers.
Maintain and update CAQH profiles and payer portals.
Track credentialing timelines, expirations, and revalidation requirements.
Maintain provider rosters, contracts, and fee schedules.
Coordinate with leadership on payer enrollment strategies and reimbursement updates.
Submit and track prior authorizations for behavioral health services.
Monitor utilization limits and ensure services align with authorized units and treatment plans.
Collaborate with clinicians to resolve authorization and documentation issues.
Ensure compliance with HIPAA, Medicaid/Medicare regulations, and behavioral health documentation standards.
Maintain audit-ready documentation and support internal/external audits.
Monitor regulatory and payer policy updates and translate them into operational changes.
Serve as a primary point of contact for billing inquiries, providing clear and compassionate support to clients.
Explain EOBs, balances, and payment options; assist with payment plans as needed.
Collaborate cross-functionally with finance, clinicians, and People Ops to resolve billing and credentialing issues.
Utilize EHR billing systems (Procentive or similar) and payer portals efficiently.
Maintain accurate billing records, reporting dashboards, and documentation templates.
Use spreadsheets and reporting tools to analyze billing data and support decision-making.
Handle other billing- and credentialing-related tasks as assigned by the Finance Manager, including participating in special projects and trainings.