Medical Billing Specialist – (Mid-Level)

Journey Through Life•Houston, TX

1d•Hybrid

About The Position

JTL is seeking a detail-oriented Behavioral Health Billing Specialist to support full-cycle revenue cycle operations for their outpatient behavioral health clinic in Houston, Texas. This mid-level role is responsible for day-to-day billing, payment posting, accounts receivable follow-up, and prior authorization coordination for Texas STAR program(s), STAR managed care plans, and private/commercial insurance. The ideal candidate is an experienced medical biller who can work independently on routine billing and A/R tasks and collaborate with leadership on more complex denials, audits, and recoupments. You understand behavioral health revenue-cycle workflows, clean claim submission, payer follow-up, prior-authorization tracking, ERA/EOB reconciliation, and compliance-sensitive documentation. You will work closely with clinical, intake, and administrative teams to ensure that services are billed accurately, supported by documentation, and reimbursed promptly. This mid-level role offers growth into senior revenue cycle responsibilities as you help refine processes and demonstrate strong performance.

Requirements

3+ years of medical billing or healthcare revenue cycle experience, including at least 1 year working with STAR managed care plans or similar state health programs.
Experience billing Texas STAR program(s) and/or TMHP-administered STAR claims strongly preferred.
Familiarity with STAR managed care plans and private insurance billing, including prior authorizations, denials, appeals, and payer follow-up.
Working knowledge of CPT, HCPCS, ICD-10, CMS-1500, EDI claims, ERA/EOB reconciliation, and A/R workflows.
Experience using EHR/EMR or practice management systems for scheduling, documentation, and billing.
Strong attention to detail, organization, and follow-through, with the ability to manage multiple payers and priorities.
Ability to communicate professionally with payers, patients, providers, and internal team members.
Understanding of HIPAA and patient confidentiality requirements.

Nice To Haves

Behavioral health billing experience with outpatient therapy, crisis intervention, PHP, IOP, SUD, or community mental health programs.
Experience with TMHP, Availity, Change Healthcare, or similar clearinghouses and payer portals.
Experience with EHR or practice management platforms (e.g., insert your system name).
Billing or coding certification such as CPB, CPC, CBCS, CMRS, or related credential.
Bilingual English/Spanish is a plus for the Houston patient population.
Strong Excel and reporting skills, including A/R aging, claims tracking, and denial trend analysis.
Experience supporting provider credentialing, payer enrollment, CAQH updates, or provider profile maintenance.

Responsibilities

Prepare, review, and submit accurate claims for Texas STAR program(s), STAR managed care plans, Medicare (if applicable), and commercial/private insurance payers for outpatient behavioral health services.
Apply appropriate ICD-10 diagnosis pairing, CPT/HCPCS codes, modifiers, place of service, payer rules, and documentation requirements to ensure clean claim submission.
Submit claims electronically through clearinghouses and payer portals (e.g., TMHP, Availity, Change Healthcare) and monitor claim acceptance, front-end edits, and rejections.
Review patient accounts and billing documentation to confirm claims are complete, accurate, and compliant before submission.
Research and resolve claim edits and rejections; coordinate corrected claims and rebills as needed to support timely reimbursement.
Post insurance payments and patient payments, and reconcile ERA/EOB remittances for STAR programs, STAR managed care plans, and commercial payers.
Track unpaid, denied, rejected, underpaid, and partially paid claims, maintaining accurate documentation in patient accounts and billing systems.
Work A/R aging reports, conduct regular claim status checks, and follow up proactively with payers to reduce days in A/R.
Research and resolve denials, appeals, recoupments, takebacks, and payment discrepancies, with support from leadership on complex issues.
Identify billing trends or process issues that could impact reimbursement and recommend improvements to workflows and policies.
Coordinate prior authorizations for PHP and outpatient mental health services (e.g., therapy, IOP, crisis intervention), in alignment with STAR plan requirements and commercial payer policies.
Submit and track authorization requests through payer portals, TMHP PA on the Portal, fax, or other payer-required channels.
Collect required clinical documentation from providers, including diagnosis, medical necessity support, requested units, service dates, and provider information.
Track authorization start dates, end dates, approved units, expirations, and extension needs, and communicate status updates to clinicians, schedulers, intake staff, and leadership.
Verify patient eligibility, behavioral health benefits, copays, coinsurance, deductibles, visit limits, and authorization requirements before billing.
Support patient billing inquiries with professionalism, accuracy, and empathy.
Coordinate patient balances, payment plans, and billing questions with intake, front desk, and administrative team members.
Communicate coverage or billing issues to clinical and administrative staff promptly to avoid gaps in care or billing delays.
Collaborate with facility staff and internal departments to obtain missing documentation necessary for claim submission and audit readiness.
Maintain billing workflows that support HIPAA, payer policy compliance, audit readiness, and documentation sufficiency.
Help ensure medical necessity documentation, session times, service dates, provider credentials, diagnosis codes, treatment plans, and clinical notes support claims.
Stay current on payer updates, STAR program and TMHP guidance, NCCI/MUE edits, STAR billing rules, and commercial payer requirements relevant to behavioral health services.
Identify documentation gaps before claim submission and escalate issues to clinical or administrative leadership.
Assist with internal billing audits, payer audits, retrospective reviews, and recoupment defense as needed, in collaboration with leadership.