Behavioral Health Coding and Billing Specialist

Job Description

Job Description

Organization Overview :

SoundCommunity Services, Inc. is a private, not-for-profit organization dedicated toeducating, assisting, and supporting individuals with persistent mental illnessand substance use disorders. We work tirelessly to create a culture andenvironment in which recovery and wellness are possible.

Position Overview :

The Behavioral Health Coding and Billing Specialist is critical in ensuring the accuracy, compliance, and efficiency of coding and billing practices for the organization. The work location will be onsite at the 21 Montauk Ave. New London, CT location, with potential for some hybrid work after the successful completion of the probationary period. The Behavioral Health Coding and Billing Specialist is responsible for supporting coding workflows, monitoring dashboards, monitoring and resolving denials, coordinating with teams, and supporting quality improvement initiatives. The Behavioral Health Coding and Billing Specialist will collaborate with departments to promptly resolve barriers to coding completion and denials. The ideal candidate will have a strong background in coding, regulatory compliance, and data analysis, with a proactive approach to problem-solving and process improvement.

This position will work with the Finance Department, Outpatient Clinic Team, and the Revenue Cycle Management vendor on revenue cycle performance to meet short term strategic goals and will provide analysis and create written guidelines, policies, and procedures in accordance with implementation of all work processes. The expectation of the position is to incorporate the company’s vision, mission and values in the position.

Essential Functions :

Coding Review & Resolution

• Responsible for resolving claims edit denials prior to billing.
• Review accounts that are not final billed to identify coding-related issues and determine appropriate resolution actions.
• Investigate and resolve coding denials in coordination with relevant departments.
• Review accounts flagged by coding systems or other departments for accuracy and compliance.
• Apply and adhere to outpatient and external coding guidelines and regulations.

Conduct research to resolve complex coding issues.

Collaborate with other departments to resolve coding and billing issues.

Identify non-compliant coding, documentation, and billing practices.

Client and Internal Billing Support

Continuous Process Improvement and Teamwork

Other duties as assigned.

Physical Requirements :

While performing the duties of this job, the employee is regularly required to sit, use hands to finger, handle or feel objects, tools, or controls, and climb stairs. The employee frequently is required to walk, talk and / or hear; Speaking and hearing ability sufficient to communicate effectively by phone or in person at normal volumes; Vision adequate to read correspondence, computer screen, forms, etc. The employee is occasionally required to stand and climb or balance. The employee must occasionally lift and / or move up to 25lbs. Specific vision abilities required by this position include the ability to adjust focus.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Qualifications :

Sound Community Services, Inc. is an equal opportunity employer. All employment decisions are made without regard to race, color, age, gender, gender identity or expression, sexual orientation, marital status, pregnancy, religion, citizenship, national origin / ancestry, physical / mental disabilities, military status, or any other basis prohibited by law. EOE, M / F / D / V