Mental and Behavioral Health Biller and Credentialing Specialist
This is a remote position.
Mental & Behavioral Health Biller & Credentialing Specialist
About the Role
We are seeking a senior-level Mental & Behavioral Health Biller & Credentialing Specialist who owns the full revenue cycle from provider enrollment to clean claim to payment resolution. This role is critical to ensuring clinicians are credentialed correctly, claims are submitted accurately, denials are prevented (not just fixed), and revenue flows consistently.
This position requires deep experience in mental/behavioral health billing, strong Medicaid and commercial payer knowledge, and proactive collaboration with clinical, HR, and operations teams.
Key Responsibilities
Billing & Revenue Cycle Management
Submit, track, and resolve claims for mental and behavioral health services including therapy, school-based services, and telehealth
Maintain a high clean-claim rate through accurate CPT coding, modifiers, POS, and provider configuration
Monitor and manage accounts receivable; actively work claims aged 30/60/90+ days
Identify denial trends and implement corrective actions to reduce future denials
Prepare and submit appeals with supporting documentation
Post ERAs and payments accurately; reconcile payer remittances
Verify benefits, eligibility, and authorization requirements as needed
Ensure compliance with Medicaid and commercial payer billing regulations
Provider Credentialing & Enrollment
Manage end-to-end credentialing for therapists and prescribers across payers and states
Complete and maintain CAQH profiles and re-attestations
Submit and track individual and group enrollments
Coordinate site-specific or school-based enrollments when required
Track credentialing timelines and follow up proactively with payers
Manage re-credentialing cycles to prevent lapses in billing eligibility
Compliance & Quality
Ensure billing aligns with clinical documentation, supervision requirements, and payer rules
Identify and flag unbillable or high-risk services before claims submission
Maintain HIPAA compliance in all billing and credentialing activities
Stay current on payer rule changes and regulatory updates
Collaboration & Communication
Work closely with clinicians to resolve documentation or coding issues
Partner with HR/onboarding to ensure credentialing is initiated early
Communicate clearly with clinical leadership regarding revenue risks or delays
Educate providers on common billing and documentation issues when needed
Reporting & Performance Metrics
Provide regular reports on:
Claim volume and denial rates
AR aging
Credentialing status and timelines
Revenue trends and risks
Meet defined benchmarks for clean-claim rate, AR days, and credentialing turnaround
Required Qualifications
7–10+ years of mental and behavioral health billing experience
Hands-on experience with Medicaid and commercial payers
Strong credentialing experience (CAQH, individual & group enrollments)
Familiarity with mental health CPT codes, modifiers, and POS rules
Experience with EHR/practice management systems and clearinghouses
High attention to detail with strong follow-through
Ability to work independently and manage competing priorities
Preferred
Multi-state billing and credentialing experience
School-based mental health billing experience
Experience scaling billing operations in a growing organization