Evolve Managed Care Solutions · 1 month ago
Mental Health Billing Specialist – Denials, Credentialing, & Insurance
Augusta, GA
Full-time
Onsite
Entry, Mid Level
2+ years expEvolve Managed Care Solutions is a trusted psychiatric and behavioral health service provider committed to delivering high-quality mental health care. They are seeking an experienced Mental Health Billing Specialist responsible for managing claim denials, appeals, and insurance credentialing processes to ensure the financial success of the practice.
Mental Health Care
Responsibilities
Review, analyze, and resolve denied or underpaid claims in a timely manner
Prepare and submit appeals for denied claims, ensuring compliance with payer guidelines
Track and follow up on outstanding claims, correcting errors to secure payment
Work closely with insurance companies to identify trends in denials and implement corrective actions
Manage provider credentialing and re-credentialing processes with Medicaid, Medicare, and commercial payers
Ensure all provider credentials are up to date and compliant with insurance company requirements
Conduct insurance verification for new and existing patients, confirming benefits, eligibility, and coverage details
Maintain detailed records of provider contracts, enrollment status, and credentialing applications
Utilize HCA Clinical Works for billing, claims processing, and account reconciliation
Maintain compliance with HIPAA, payer policies, and industry regulations
Assist with patient billing inquiries and develop payment plans as needed
Generate reports on claim status, denials, credentialing progress, and revenue cycle trends
Qualification
Required
Minimum 2-3 years of experience in medical billing, with a focus on mental health or behavioral health services
Proven experience in denials management, appeals, and insurance follow-up
Strong understanding of insurance credentialing, provider enrollment, and payer requirements
Proficiency in HCA Clinical Works and other electronic billing systems
Familiarity with Medicaid, Medicare, and commercial insurance payers
Knowledge of CPT codes, ICD-10 coding, and mental health billing regulations
Ability to analyze denial trends and implement solutions to optimize revenue
Excellent problem-solving, communication, and organizational skills
Preferred
Certification in Medical Billing & Coding (CPC, CPB, or similar) is a plus
Experience working in a psychiatric or behavioral health practice
Knowledge of prior authorization processes for mental health services
Company
Evolve Managed Care Solutions
Evolve Managed Care Solutions (EMCS) is a patient-centric organization committed to improving health outcomes, minimizing costs, and enhancing patient satisfaction.
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase