Behavioral Health Billing and Coding Specialist in Jacksonville, Florida at ANGEL KIDS PEDIATRICS, P A

Behavioral Health Billing and Coding Specialist
Department: Behavioral Health and Social Services
Reports to: Behavioral Health Manager / Director
Supervisory responsibility: None
Position Summary
The Behavioral Health Billing and Coding Specialist manages accurate coding, timely claims submission, and payment resolution for Angel Kids Pediatrics’ behavioral health services. This experienced, certified professional supports the revenue cycle from insurance verification and authorization through claim resolution and account reconciliation. The specialist works with behavioral health leadership, the billing team, clinicians, and front desk staff to reduce preventable billing errors and support timely patient access.
Essential Responsibilities
• Review and submit claims for psychological and developmental testing, diagnostic evaluations, individual and group therapy, and collaborative care or care coordination services offered by the practice. Validate CPT, HCPCS, and ICD-10-CM coding, modifiers, units, time requirements, rendering providers, and payer-specific billing rules.
• Review documentation for support of billed services and identify missing information before submission. Obtain clarification from clinicians when needed and route documentation or coding concerns to the appropriate leader.
• Verify behavioral health eligibility and benefits, including network participation, deductibles, copayments, coinsurance, service limits, referrals, and telehealth coverage. Communicate coverage findings and scheduling barriers to the appropriate team.
• Prepare, submit, and track prior authorization requests and renewals. Confirm approved services, providers, dates, and units align with scheduled care; escalate delays, discrepancies, and services at risk of authorization expiration.
• Resolve claim rejections, denials, underpayments, and unpaid claims through payer follow-up, corrected claims, reconsiderations, and appeals. Track timely filing and appeal deadlines and document actions through resolution.
• Post and reconcile payments, contractual adjustments, and remittance information. Investigate payment variances and unapplied funds, reconcile outstanding accounts, and route refunds or noncontractual adjustments for approval.

Essential Responsibilities Continued
• Review aging and unbilled encounter reports, prioritize outstanding accounts, and provide leadership with updates on collections, denials, authorization turnaround times, and unresolved revenue cycle barriers.
• Respond professionally to family billing questions and explain statements, coverage, and financial responsibility. Coordinate payment options according to practice policy and escalate disputed or complex accounts.
• Maintain confidential, accurate billing records and support payer audits, documentation reviews, and corrective actions. Monitor payer updates, identify recurring errors, and recommend workflow improvements and staff education.
Required Qualifications
• High school diploma or GED.
• At least three years of medical billing and claims experience, including at least two years of direct behavioral or mental health billing and coding experience. General medical billing experience alone does not meet this requirement.
• Current certification in behavioral health billing or coding, or an active nationally recognized billing or coding credential such as CPC, CPB, CCS, or CCS-P accompanied by documented behavioral health billing and coding training. Certification must remain active throughout employment.
• Demonstrated experience billing psychological testing and psychotherapy, with working knowledge of behavioral health CPT, HCPCS, ICD-10-CM, modifiers, timed services, claim edits, and documentation requirements.
• Experience with commercial insurance, Medicaid managed care, eligibility and benefits verification, prior authorizations, denials and appeals, payment posting, and accounts receivable follow-up.
• Proficiency with electronic health records, billing systems, payer portals, and Microsoft Excel. Strong attention to detail, independent problem-solving, organization, and professional communication with families, clinicians, and payers.
Preferred Qualifications
Experience in pediatric or integrated behavioral health settings; Office Practicum; TRICARE; collaborative care billing; and payer audits or staff training. Associate degree or additional coursework in medical billing, coding, health information, or a related field preferred.
Performance Expectations
Maintain accurate claims and account records, meet assigned submission and follow-up deadlines, monitor authorization status, and communicate barriers promptly. Performance is evaluated using practice-established measures for billing accuracy, clean claims, denial resolution, aging, collections, and authorization turnaround.

Work Environment and Physical Requirements
Medical office setting with frequent computer use and communication with patients, families, providers, and payers. Requires sustained attention to detailed records, the ability to manage competing priorities, and occasional handling of office materials weighing up to 20 pounds, with reasonable accommodation as applicable.