ALL IN SOLUTIONS

Operations

• Direct the billing and collection workflows for all levels of addiction and mental health treatment across three states
• Enforce strict adherence to state-specific billing mandates and commercial payer contracts
• Collaborate closely with Utilization Review (UR) and Clinical teams to guarantee treatment authorizations and clinical documentation
• Supervise timely and precise claim generation, submission, payment posting, and account reconciliation processes
• Manage denial appeals and prevention efforts to minimize revenue leakage
• Ensure billing systems accurately reflect current payer fee schedules and reimbursement policies
• Track and analyze key performance indicators (KPIs) for process improvement
• Lead, train, and mentor the revenue cycle team

Revenue Cycle Manager – Substance Abuse Treatment Operations

Billing Specialist

• Prepare, audit, and submit timely and accurate electronic and paper claims to commercial payers, Medicaid, and Medicare across multiple states (NJ, FL, CA) for all levels of care (Detox, Residential, PHP, IOP).
• Accurately post electronic remittances (ERAs) and manual payments, reconciling them to patient accounts and preparing daily deposit reports.
• Research and resolve denied claims by identifying the root cause (e.g., authorization, coding, or documentation issues).
• Prepare and submit clear, complete documentation for claims reconsideration or appeal processes.
• Proactively manage and work aging A/R by contacting payers, resolving outstanding balances, and documenting all follow-up actions efficiently.
• Apply correct CPT, HCPCS, and ICD-10 codes for behavioral health and SUD services to ensure clean claim submission and regulatory compliance.
• Serve as a direct point of contact for payers to resolve claim rejections, verify benefit details, and confirm authorization requirements.
• Maintain meticulous records of all billing activities, communications, and remittance advice to ensure readiness for HIPAA and payer audits.

Billing Specialist – Substance Abuse Treatment Operations

• Conduct and submit timely and accurate pre-certifications, concurrent reviews, and continued stay authorizations for clients across all levels of care (Detox, Residential, PHP, IOP).
• Proficiently utilize and document against established medical necessity criteria, including ASAM Criteria, LOCUS, and InterQual, to support clinical justification for treatment.
• Prepare and submit clear, clinically sound documentation for the initial stages of denial appeal and grievance processes.
• Maintain detailed and organized UR documentation within the Electronic Medical Record (EMR), ensuring all records are audit-ready and compliant with internal and external standards.
• Serve as a knowledgeable and professional point of contact for routine communications with payer representatives (insurance companies) regarding authorization requests and follow-up.
• Collaborate with the UR Manager and clinical team to ensure documentation supports full compliance with state licensing regulations (NJ DOH, FL DCF, CA DHCS) and accreditation standards (CARF/Joint Commission).
• Maintain current knowledge of relevant changes to payer guidelines, medical necessity criteria, and state/federal regulations that impact UR processes.

Revenue Cycle Manager – Substance Abuse Treatment Operations

Billing Specialist – Substance Abuse Treatment Operations

Utilization Review Specialist – Substance Abuse Treatment Operations