Outpatient Billing Specialist - Substance Use Disorder and Mental Health Facility

Outpatient Billing Specialist – Substance Use Disorder (SUD) and Mental Health Facility

Position Summary

The Outpatient Billing Specialist for a Substance Use Disorder (SUD) and mental health facility plays a crucial role in the financial health of the organization by overseeing and executing billing processes specific to outpatient SUD and mental health services. This position is responsible for scheduling appointments, preparing and submitting claims, resolving billing issues, and ensuring that billing practices align with regulatory requirements unique to behavioral health and substance use treatment. The specialist works closely with clinical teams, patients, and payers to maximize reimbursement, maintain compliance, and support the mission of the facility.

Key Responsibilities

· Prepare, review, and submit claims for outpatient SUD and mental health services to insurance companies and third-party payers, ensuring accuracy and completeness with attention to behavioral health codes and regulations.

· Verify patient insurance eligibility, benefits, and coverage for SUD and mental health services prior to treatment.

· Resolve claim denials, rejections, and discrepancies by communicating with insurers, patients, providers, and behavioral health case managers.

· Post payments, adjustments, and denials to patient accounts, ensuring proper allocation of funds as per behavioral health billing standards.

· Maintain comprehensive documentation of billing activities, correspondence, and compliance for audit purposes, especially regarding state and federal SUD and mental health regulations.

· Respond to patient billing inquiries and explain charges, payments, and insurance coverage relevant to SUD and mental health treatments in a clear and empathetic manner.

· Monitor accounts receivable and follow up on unpaid or underpaid claims, focusing on timely reimbursement for substance use disorder services.

· Stay current with payer policies, coding guidelines (including CPT, ICD-10, and behavioral health codes), and regulatory changes affecting SUD and mental health billing practices.

· Assist the finance department with reconciliation and reporting related to SUD and mental health programs and outpatient services.

· Other administrative tasks as assigned.

Qualifications

· High school diploma or equivalent required; associate degree or certification in medical billing or behavioral health billing preferred.

· Minimum of 2 years’ experience in medical billing, with direct experience in outpatient substance use disorder or mental health services strongly preferred.

· Working knowledge of healthcare billing systems, behavioral health insurance plans, and terminology related to SUD and outpatient mental health care.

· Solid understanding of CPT, ICD-10, and behavioral health-specific coding, as well as HIPAA and confidentiality requirements for SUD and mental health treatment.

· Strong organizational skills and attention to detail.

· Ability to communicate compassionately and effectively with patients, providers, and payer representatives.

· Proficiency in Microsoft Office and electronic health record (EHR) systems, preferably those used in behavioral health settings.

· Experience with obtaining health plan contracts and credentialing providers a plus.

Work Environment and Work Hours

· Must be present in the office.

· 24 hours per week. Afternoon hours. Schedule to be mutually agreed upon.

Competencies:

• Problem Solving--Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Project Management--Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.
• Technical Skills--Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.
• Customer Service--Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Interpersonal Skills--Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Oral Communication--Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Written Communication--Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
• Teamwork--Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
• Organizational Support--Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
• Attendance/Punctuality--Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.

Physical Demands:

• Occasionally required to stand
• Continually required to walk
• Continually required to sit
• Continually required to utilize hand and finger dexterity
• Occasionally required to climb, balance, bend, stoop, kneel or crawl
• Continually required to talk or hear
• Continually utilizes visual acuity to operate equipment, read
• technical information, and/or use a keyboard
• Occasionally required to lift/push/carry items less than 25 pounds
• Continual exposure to bloodborne and airborne pathogens or infectious materials
• Specialized equipment: all office equipment

To apply for this position, please email resume to kmatzek@kinnicfalls.org. Closing date: March 31, 2026

Pay: $24.50 - $28.43 per hour

Work Location: In person