Medical Biller

Newport County Community Mental Health Center•Middletown, RI

6d•Onsite

About The Position

The CCBHC Medical Biller supports timely, accurate reimbursement by coding services, submitting claims, resolving denials and payment discrepancies, and maintaining complete billing documentation. This role requires working knowledge of the Prospective Payment System (PPS) model, Medicaid and commercial payer billing requirements, and compliance with applicable state and federal CCBHC guidelines.

Requirements

3+ years of medical billing experience, preferably in behavioral health or healthcare revenue cycle operations
Knowledge of CCBHC or FQHC billing models, including PPS reimbursements
Proficiency in CPT, ICD-10, and HCPCS coding
In-depth understanding of Medicaid, Medicare, and commercial insurance billing
Experience with billing systems and EMRs (e.g., Echo, Acorn preferred)
Strong analytical skills with the ability to interpret billing data and resolve complex issues
Excellent organizational skills with the ability to manage multiple priorities and meet deadlines
High attention to detail and commitment to compliance, accuracy, and confidentiality
Proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint)

Responsibilities

Execute end-to-end CCBHC billing, including PPS-2 claim/encounter submission, ensuring all encounter and payer requirements are met.
Ensure accurate coding and claim quality (ICD-10/CPT) for behavioral health, SUD, and integrated services; partner with clinical/operational teams to resolve documentation and coding gaps.
Submit electronic claims via clearinghouse/EDI to Medicaid, Medicare, and commercial payers; identify and resolve submission rejections and system edits.
Manage denials and underpayments by researching issues, correcting/resubmitting claims, filing appeals, and communicating with payers; analyze denial trends and recommend process improvements to maximize reimbursement.
Maintain patient accounts and billing data (demographics, insurance, eligibility verification, and authorizations) to support clean claims and timely payment.
Post payments/adjustments and reconcile EOBs/remittances; ensure accurate cash posting and account reconciliation.
Perform A/R follow-up and patient balance resolution, including proactive outreach and clear communication regarding financial responsibility and billing questions.
Maintain compliant billing documentation and support audits, compliance reviews, reporting, and related revenue cycle activities as assigned.