Position Type: Part‑Time (15–25 hours/week)
Reports To: Billing Manager / Practice Manager
Location: Hybrid (Naperville + remote)
Program Areas: Medicaid (Illinois), MCOs, Commercial Insurance (as assigned)

Position Summary
The Part‑Time Behavioral Health Biller is responsible for ensuring accurate, timely, and compliant billing for mental health services delivered to Illinois Medicaid and MCO clients. This role supports the full revenue cycle—from claim creation to payment posting and denial resolution—while maintaining strict adherence to Illinois HFS, MCO, and behavioral‑health documentation requirements.
The ideal candidate understands the nuances of community mental health billing, including modifiers, service codes, LPHA/QMHP/MT billing distinctions, and the unique requirements of Illinois Medicaid programs.

Core Responsibilities
1. Claims Creation & Submission

• Review clinical documentation for completeness and Medicaid compliance.
• Create and submit claims for Medicaid, Medicaid MCOs, and commercial payers.
• Ensure correct use of CPT/HCPCS codes, Illinois Medicaid modifiers (HN, HO, AH, AJ, etc.), and place‑of‑service codes.
• Verify that services meet medical necessity and program requirements (e.g., IATP alignment).

2. Eligibility & Authorization Management

• Conduct Medicaid eligibility checks (HFS MEDI, MCO portals).
• Track authorizations, service limits, and reauthorization dates.
• Communicate with clinicians regarding missing or expiring authorizations.

3. Payment Posting & Reconciliation

• Post ERA/EOB payments accurately.
• Reconcile payments with bank deposits and billing system reports.
• Identify underpayments or payer discrepancies.

4. Denial Management & Follow‑Up

• Review and resolve claim denials, rejections, and pended claims.
• Correct and resubmit claims within payer timelines.
• Track denial trends and report issues to leadership.

5. Compliance & Documentation Review

• Ensure documentation meets Illinois Medicaid standards, including:
• IATP alignment
• LPHA sign‑off requirements
• Service note timeliness
• Required elements for community‑based services
• Maintain HIPAA compliance at all times.

6. Communication & Collaboration

• Communicate with clinicians regarding documentation corrections or missing elements.
• Collaborate with leadership to improve billing workflows.
• Maintain professional communication with Medicaid/MCO representatives as needed.

Required Qualifications

• Minimum 1–2 years of behavioral‑health billing experience.
• Strong understanding of Illinois Medicaid and MCO billing rules.
• Familiarity with CPT/HCPCS codes used in mental health (90791, 90832/34/37, H0032, H2019, T1016, etc.).
• Experience with modifiers (HN, HO, AH, AJ, GT/95, etc.).
• Proficiency with billing software Simple Practice, Medi System
• Strong attention to detail and ability to work independently.
• Knowledge of HIPAA and confidentiality standards.

Preferred Qualifications

• Experience with community mental health or Medicaid-heavy caseloads.
• Familiarity with Illinois HFS guidelines, IATP requirements, and MCO portals.
• Experience with denial management and RCM optimization.
• Strong communication skills for clinician collaboration.

Hours & Compensation

• 20–25 hours per week, flexible scheduling.
• Hybrid work model
• This position requires you to be able to be in the office as needed. Applicants out of state will be denied.
• Compensation based on experience and Medicaid billing proficiency.

Key Performance Indicators (KPIs)

• Claim submission within 48–72 hours of documentation completion.
• Denial rate below 5–8%.
• Timely posting of payments (within 3–5 business days).
• Accurate authorization tracking with zero lapses.
• Monthly reporting of billing trends and issues.

Pay: $15.00 - $20.00 per hour

Benefits:

• Flexible schedule

Application Question(s):

• Do you have history of medicaid billing?
• Do you have a history of mental health billing?
• How many years of experience do you have in billing
• Are you able to be in the office as required?

Work Location: In person