QMHP Billing Specialist

GLADNEY CENTER FOR ADOPTION•Fort Worth, TX

4d•Onsite

About The Position

The QMHP Billing Specialist is responsible for accurate and timely billing of Qualified Mental Health Professional (QMHP) services and ensuring that QMHP staff meet and maintain the credentialing requirements needed to deliver and bill those services. The role works closely with clinical staff, program leadership, and external payers to protect revenue integrity and maintain program compliance. The position handles billing and revenue-cycle activities, including reviewing service documentation, preparing and tracking claims, resolving denials, posting payments, verifying eligibility and authorizations, and reporting on billing and accounts receivable. It also maintains credentialing records for QMHP and QMHP-eligible staff, monitors credentials and deadlines, coordinates verification and applications with Human Resources and clinical supervisors, and supports audits. The specialist provides feedback and brief training to clinical staff, communicates with payers, and protects confidential client and personnel information in accordance with HIPAA and agency policy.

Requirements

High school diploma or equivalent.
Two years of experience in behavioral health billing.
Working knowledge of Medicaid and managed care billing, CPT/HCPCS coding, prior authorization processes, and claim denial resolution.
Strong attention to detail and organizational skills, with the ability to manage multiple deadlines.
Proficiency with electronic health record and billing software and Excel or similar tools.
Ability to maintain confidentiality and work within HIPAA requirements.
Understanding of behavioral health service documentation standards.
Clear written and verbal communication skills.
Ability to work independently and collaboratively.
Sound judgment in handling sensitive and compliance-related matters.

Nice To Haves

Associate degree or relevant coursework.
Experience with QMHP billing.
Experience tracking provider credentialing or enrollment.
Billing or coding certification, such as CPC or CMRS.
Familiarity with state-specific QMHP definitions and requirements.

Responsibilities

Review service documentation to verify that it supports the billed service, including service type, date, duration, and provider credentials.
Enter charges and prepare, submit, and track claims to Medicaid, managed care organizations, and other payers.
Follow up on denied, rejected, and unpaid claims and submit corrections and appeals within payer deadlines.
Stay current with changes in billing codes, laws, and payer requirements.
Post payments and adjustments and reconcile accounts.
Verify client eligibility and authorizations and track authorization units and expiration dates.
Prepare regular billing, denial, and accounts receivable reports for leadership.
Identify denial and documentation-error trends and recommend process improvements.
Maintain current credentialing files and tracking systems for QMHP and QMHP-eligible staff, including records of degrees, transcripts, licenses or registrations, supervised experience, and required training.
Confirm staff credential status before they are scheduled to provide or bill QMHP services.
Track credential expirations, renewals, continuing education, and supervision requirements, and notify staff and supervisors of upcoming deadlines.
Coordinate with Human Resources and clinical supervisors on onboarding, primary source verification, and credential applications.
Ensure only appropriately credentialed staff are billed as QMHPs and promptly flag gaps to leadership.
Monitor changes to state, payer, and licensing board QMHP requirements and update internal tracking and procedures.
Assemble credentialing and billing records for internal audits and external payer or state audits.
Provide feedback and brief training to clinical staff on documentation and billing requirements.
Serve as the payer point of contact for billing and provider enrollment questions.
Maintain confidentiality of client and personnel information in accordance with HIPAA and agency policy.