Job Description
Job DescriptionSalary:
Job Description Billing Specialist (Contract)
Company: Wise Path Recovery Centers (in partnership with Ascension Recovery Services)
Location: Remote must reside in Eastern or Central Time Zone
General Description
The Billing Specialist supports the financial health of Wise Path Recovery Centers by ensuring accurate, timely, and compliant billing for behavioral health and substance use disorder (SUD) services provided across our West Virginia programs. This role works closely with utilization review, admissions, and third-party billing partners to submit claims, track payments, resolve denials, and maintain compliance with state and federal regulations.
Essential Duties
- Prepare and submit clean claims for behavioral health/SUD services to Medicaid, Medicare, and commercial payors.
- Verify patient insurance coverage and benefits prior to admission and update information in the EMR and billing system.
- Reconcile billing data between EMR and payor portals; ensure accuracy of coding, authorizations, and documentation.
- Monitor claim status, follow up with payors, and resolve denials or underpayments promptly.
- Collaborate with Utilization Review Specialists to confirm active authorizations and correct billing details.
- Maintain accurate records of charges, payments, adjustments, and patient balances.
- Prepare financial reports for leadership and assist with month-end reconciliation.
- Communicate with patients regarding billing questions, payment plans, and financial responsibility in a professional manner.
- Ensure compliance with West Virginia DHHR, Medicaid, and federal regulations.
- Identify trends in billing or denial issues and recommend process improvements.
Qualifications
- High school diploma or equivalent required; Associates or Bachelors degree in Accounting, Business, or related field preferred.
- Minimum 2 years experience in medical billing, coding, or healthcare revenue cycle management.
- Behavioral health or SUD treatment billing experience strongly preferred.
- Knowledge of West Virginia Medicaid billing guidelines and commercial payor requirements.
- Familiarity with CPT, HCPCS, and ICD-10 coding.
- Proficiency in EMR systems and payor portals.
- Strong attention to detail, organizational skills, and ability to meet deadlines.
- Excellent written and verbal communication skills.
Key Competencies
- Accuracy & Detail Orientation: Ensures claims are complete, correct, and compliant.
- Problem Solving: Identifies and resolves claim errors, denials, and discrepancies.
- Collaboration: Works effectively with UR, clinical, and finance teams.
- Confidentiality: Maintains strict patient confidentiality under HIPAA.
- Regulatory Knowledge: Understands West Virginia Medicaid billing requirements and payer standards.
- Customer Service: Provides clear, respectful support to patients and payors.
Work Conditions
- Remote position; must reside in Eastern or Central Time Zone.
- Standard business hours with occasional flexibility for deadlines.
- Primarily computer-based work in billing and payer portals.
- Some phone interaction with payors and patients required.
Performance Expectations
- Submit clean claims with minimal errors or denials.
- Ensure timely follow-up on outstanding claims and accounts receivable.
- Maintain accurate billing records and reports.
- Demonstrate strong compliance with HIPAA, 42 CFR Part 2, and state/federal billing regulations.
- Support continuous improvement in billing and revenue cycle processes.
Equal Employment Opportunity Statement
Wise Path Recovery Centers, in partnership with Ascension Recovery Services, provides equal employment opportunities to all employees and applicants. We comply with all federal, state, and local employment laws and prohibit discrimination or harassment based on race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, or any other protected status.
remote work