Medical Billing Specialist – Lead

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Oversee the entire billing cycle in TherapyNotes, which includes charge entry, claim scrubbing, batch submission, resubmission, and managing claim holds.

• Process ERAs and EOBs; post insurance payments, adjustments, and denials; and reconcile these against deposits.

• Administer payer and code configuration within the practice management system.

• Handle insurance accounts receivable, conduct aging reviews, and manage unpaid or underpaid claims.

• Investigate and resolve denials; file and monitor appeals until resolution.

• Identify recurring causes of denial and suggest preventive process modifications.

• Review CPT and ICD-10 coding for outpatient behavioral health claims.

• Apply and verify modifiers, place-of-service codes, and telehealth coding.

• Collaborate with clinicians and client care to rectify coding issues at their origin.

• Stay updated with coding changes and payer policy updates.

• Assist with provider credentialing and re-credentialing; keep files and deadlines organized.

• Complete and maintain CAQH profiles.

• Submit and track commercial payer applications; support payer enrollment and contracting efforts.

• Maintain accurate records of licenses, certifications, malpractice insurance, NPI information, and credentialing documentation.

• Serve as a billing point of contact for clients, clinicians, client care, and the administrative team.

• Report assigned scorecard metrics and document owned workflows; facilitate cross-training for teammates.

• Uphold strict confidentiality of protected health information and ensure HIPAA compliance.

• At the Lead level: take ownership of credentialing and payer enrollment, supervise billing staff, coordinate workflows, manage department scorecard, foster payer relationships, conduct denial root-cause analysis, enforce standard operating procedures, and support onboarding and cross-training.

⛳️ Requirements

• Fluency in EHR systems; experience with TherapyNotes is strongly preferred.

• Solid understanding of CPT and ICD-10 coding.

• Familiarity with HMO/PPO, Medicare, Medicare Advantage, Medicaid managed care, and commercial payer requirements.

• Proven ability to handle ERAs, denials, and appeals independently without daily oversight.

• Exceptional organizational skills; capable of prioritizing tasks and managing multiple deadlines without reminders.

• Proficient in Excel and Google Workspace (Gmail, Docs, Sheets, Forms).

• Knowledge of the mental health sector, PHI confidentiality, and HIPAA compliance.

• Previous experience in a client or patient-facing support role.

• Resourceful, self-motivated, proactive communicator, and team-oriented.

• Possess a warm, empathetic, positive, thoughtful, and friendly demeanor.

• Passionate about supporting mental health and the community.

• For Billing Specialist: 3+ years of experience in medical billing and collections; credentialing experience is strongly preferred, and a willingness to learn is required.

• For Billing Lead: 5+ years of experience in medical billing and collections, including hands-on credentialing and experience directing the daily activities of a billing team or function.

• Hands-on provider credentialing experience, including CAQH profile management and commercial payer applications — required at the Lead level.

• Preferred: Experience in behavioral health or multi-site group practice billing.

• Preferred: Experience managing Blue Cross Blue Shield of Illinois enrollments and escalations.

• Preferred: Medicare enrollment and PECOS experience.

• Preferred: Experience reporting departmental metrics to leadership.

• Required at the Lead level: Certified Medical Biller — CPB, CMRS, or equivalent; strongly preferred at the Specialist level.

• Preferred: Coding certification — CPC, CCS, or equivalent.

• Preferred: Credentialing certification — CPCS or equivalent.

• Minimum requirement: A high school diploma or equivalent.

• Preferred: An Associate’s degree in healthcare, business, office administration, or a related field.

• Ability to work 30 hours per week within Central Standard Time business hours from Monday to Friday.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Life insurance and disability plans fully covered by the employer.

• 401k plan with employer matching contributions.

• Paid time off, vacation, and sick leave.

• Flexible scheduling options.

• Fully remote work opportunity.