Medical Biller

Gateway Health Services•Lakeville, MN

4h•$25 - $30

About The Position

Gateway Health Services Inc. is seeking an experienced, detail-oriented Medical Billing & Authorization Specialist to support its behavioral health programs, including Intensive Residential Treatment Services (IRTS) and Adult Mental Health Targeted Case Management (AMH-TCM). The role is responsible for accurate, timely claims submission; managing service authorizations; resolving denied or rejected claims; and following up on outstanding reimbursements. The specialist independently manages billing responsibilities while collaborating with clinical and administrative teams.

Requirements

At least 2 years of medical billing, insurance claims, or revenue cycle management experience.
Experience with Medicaid/Medical Assistance billing and managed care organizations.
Knowledge of insurance authorization processes, claim denials, appeals, and reimbursement procedures.
Experience working with electronic health records (EHR) and billing systems.
Strong organizational skills and attention to detail, with the ability to manage multiple deadlines.
Ability to communicate professionally with insurance companies, clinical staff, and administrative personnel.
Ability to work independently and take ownership of assigned billing responsibilities.

Nice To Haves

Previous billing experience in behavioral health, mental health, or residential treatment settings.
Familiarity with Minnesota DHS requirements for IRTS and AMH-TCM services.
Experience working with Minnesota Medicaid managed care plans, including HealthPartners, UCare, Blue Plus, and other applicable payers.
Experience with InSync/Qualifacts or similar EHR systems.
Knowledge of claim correction procedures, denial appeals, authorization tracking, and accounts receivable management.
Medical billing or coding certification (CPC, CPB, or equivalent); certification is a plus but not required.

Responsibilities

Prepare, submit, and track initial and continued-stay authorizations for IRTS services.
Monitor authorization expiration dates and coordinate timely renewal submissions.
Verify client insurance eligibility, coverage, and authorization requirements.
Communicate with insurance providers, utilization management teams, and clinical staff to obtain necessary documentation.
Maintain accurate authorization records and tracking systems.
Prepare, review, and submit accurate claims for IRTS and AMH-TCM services within payer filing deadlines.
Review billing documentation for completeness, accuracy, and compliance with payer requirements.
Monitor claims through acceptance, processing, payment, rejection, and denial.
Identify and correct billing errors involving coding, authorizations, eligibility, or documentation.
Submit corrected claims and appeals as appropriate.
Post and reconcile insurance payments and adjustments as assigned.
Investigate denied, rejected, underpaid, and unpaid claims; contact insurers to determine claim status and resolve payment issues.
Prepare and submit reconsiderations, appeals, and supporting documentation.
Monitor outstanding accounts receivable and follow up on aging claims.
Identify recurring denial trends and recommend billing process improvements.
Maintain detailed records of claim follow-up activities and resolutions.
Maintain knowledge of Minnesota DHS billing requirements, Medical Assistance policies, and applicable payer guidelines.
Ensure billing practices comply with state and federal regulations, payer contracts, and organizational policies.
Collaborate with clinical and administrative staff to address documentation deficiencies affecting billing.
Prepare regular billing reports on submitted claims, outstanding authorizations, denials, and accounts receivable.
Assist with billing audits, reconciliation, and process improvements.
Maintain confidentiality of client information in accordance with HIPAA requirements.
Manage assigned billing responsibilities independently, meet submission deadlines, and communicate consistently with program leadership.