Medical BillingUtilization Review Specialist

Turning Point Behavioral Health

Job Location:

Madison, OH - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Turning Point Behavioral Health is committed to providing exceptional care and service with compassion. We strive to provide a family of employees who feel valued and supported in an environment that inspires excellence and fulfilment. Our services support individuals seeking behavioral health and substance use disorder treatment with South Dakota serving as the primary location of responsibility for this role.

The Medical Billing / Utilization Review Specialist will be responsible for supporting the financial and clinical authorization processes for residential behavioral health and substance use disorder services. This position ensures accurate billing timely claims submission insurance verification authorization management and continued stay review coordination. The Medical Billing / Utilization Review Specialist works closely with admissions clinical and leadership teams to ensure that services are appropriately authorized documented billed and reimbursed in accordance with payer expectations and state and federal requirements. This role requires a highly organized and detail-oriented professional who is committed to helping maintain continuity of care and uninterrupted operations through strong revenue cycle and utilization review practices.

DUTIES AND RESPONSIBILITES TO INCLUDE:

Review and process billing for residential behavioral health and substance use disorder treatment services.
Verify insurance eligibility benefits authorizations and payer requirements prior to and throughout treatment episodes.
Submit clean claims and monitor claims through the full revenue cycle process to support timely reimbursement.
Manage utilization review functions including initial authorizations concurrent reviews continued stay requests peer review coordination and payer communication.
Collaborate with clinical staff to ensure documentation supports medical necessity level of care and continued stay criteria.
Track authorization periods payer deadlines denials underpayments and appeal opportunities.
Maintain accurate client account records billing data and insurance information in organizational systems.
Assist with reimbursement follow-up and collections involving Medicaid Medicare and commercial insurance payers.
Identify trends related to denied delayed or underpaid claims and communicate areas needing corrective action.
Ensure compliance with payer guidelines organizational standards and all applicable state and federal regulations.
Support operational improvement in billing utilization review and reimbursement workflows particularly for South Dakota-based services.
Communicate effectively with insurance representatives internal staff and leadership regarding authorization and billing issues.
Help ensure continuity of operations by reducing avoidable disruptions in reimbursement and authorization processes.

QUALIFICAITONS:

High school diploma or equivalent required; associates or bachelors degree in healthcare administration business billing coding or related field preferred.
Experience in behavioral health billing substance use disorder treatment billing medical billing utilization review insurance verification or revenue cycle management strongly preferred.
Knowledge of Medicaid Medicare commercial insurance prior authorization processes and payer requirements for residential treatment preferred.
Experience with CPT HCPCS ICD-10 coding UB-04 and/or CMS-1500 claim forms and electronic billing systems preferred.
Minimum of 5 years of experience in a residential treatment setting preferred.
Familiarity with South Dakota payer systems behavioral health reimbursement and regional insurance processes strongly preferred.

KNOWLEDGE SKILLS AND ABILITIES:

Strong knowledge of behavioral health billing processes payer requirements and utilization review practices.
Understanding of medical necessity criteria continued stay review processes and insurance authorization requirements for residential treatment.
Strong attention to detail and ability to maintain accurate and timely documentation and billing records.
Ability to work collaboratively with clinical admissions and administrative staff in a fast-paced treatment environment.
Effective organizational communication and problem-solving skills.
Ability to identify reimbursement issues resolve claim concerns and support appeal processes when needed.
Commitment to confidentiality professionalism and compliance with all applicable standards and regulations.
Strong working knowledge of revenue cycle management and payer communication processes.

Turning Point Behavioral Heath is an Equal Opportunity Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity or expression national origin disability or status as a protected veteran. Applicants who would like to request reasonable accommodation to the application or interview process should call Human Resources at 1- or email

Required Experience:

DUTIES AND RESPONSIBILITES TO INCLUDE:

Review and process billing for residential behavioral health and substance use disorder treatment services.
Verify insurance eligibility benefits authorizations and payer requirements prior to and throughout treatment episodes.
Submit clean claims and monitor claims through the full revenue cycle process to support timely reimbursement.
Manage utilization review functions including initial authorizations concurrent reviews continued stay requests peer review coordination and payer communication.
Collaborate with clinical staff to ensure documentation supports medical necessity level of care and continued stay criteria.
Track authorization periods payer deadlines denials underpayments and appeal opportunities.
Maintain accurate client account records billing data and insurance information in organizational systems.
Assist with reimbursement follow-up and collections involving Medicaid Medicare and commercial insurance payers.
Identify trends related to denied delayed or underpaid claims and communicate areas needing corrective action.
Ensure compliance with payer guidelines organizational standards and all applicable state and federal regulations.
Support operational improvement in billing utilization review and reimbursement workflows particularly for South Dakota-based services.
Communicate effectively with insurance representatives internal staff and leadership regarding authorization and billing issues.
Help ensure continuity of operations by reducing avoidable disruptions in reimbursement and authorization processes.

QUALIFICAITONS:

High school diploma or equivalent required; associates or bachelors degree in healthcare administration business billing coding or related field preferred.
Experience in behavioral health billing substance use disorder treatment billing medical billing utilization review insurance verification or revenue cycle management strongly preferred.
Knowledge of Medicaid Medicare commercial insurance prior authorization processes and payer requirements for residential treatment preferred.
Experience with CPT HCPCS ICD-10 coding UB-04 and/or CMS-1500 claim forms and electronic billing systems preferred.
Minimum of 5 years of experience in a residential treatment setting preferred.
Familiarity with South Dakota payer systems behavioral health reimbursement and regional insurance processes strongly preferred.

KNOWLEDGE SKILLS AND ABILITIES:

Strong knowledge of behavioral health billing processes payer requirements and utilization review practices.
Understanding of medical necessity criteria continued stay review processes and insurance authorization requirements for residential treatment.
Strong attention to detail and ability to maintain accurate and timely documentation and billing records.
Ability to work collaboratively with clinical admissions and administrative staff in a fast-paced treatment environment.
Effective organizational communication and problem-solving skills.
Ability to identify reimbursement issues resolve claim concerns and support appeal processes when needed.
Commitment to confidentiality professionalism and compliance with all applicable standards and regulations.
Strong working knowledge of revenue cycle management and payer communication processes.

Required Experience: