Job Summary:
We are seeking a detail-oriented and experienced Medical Billing Specialist to join our team, specializing in Substance use disorder and behavioral health billing. The ideal candidate will have extensive knowledge of Medicaid and commercial insurance billing requirements and processes, with a strong understanding of multiple levels of care, including residential, partial hospitalization programs (PHP), intensive outpatient programs (IOP), and outpatient programs. This position requires accuracy, efficiency, and a commitment to ensuring timely and compliant reimbursement for services rendered.
Key Responsibilities:
Prepare and submit claims to Medicaid and commercial insurance providers for behavioral health services across multiple levels of care (e.g., inpatient, outpatient, IOP, PHP, and residential).
Ensure accurate and complete coding of claims based on industry standards.
Monitor and track submitted claims to ensure timely reimbursement and minimize denials.
Investigate and resolve claim denials and discrepancies by coordinating with payers and internal staff.
Perform payment posting and reconciliation to ensure all payments are accurately recorded.
- Maintain a thorough understanding of Medicaid and commercial payer policies and stay updated on changes and requirements.
- Work closely with clinical and administrative staff to ensure accurate patient and insurance information.
Conduct regular audits to identify billing issues and implement corrective actions.
- Respond to patient and payer inquiries regarding billing issues and account status.
- Ensure compliance with HIPAA and other regulatory requirements.
- Other duties as assigned
Qualifications:
High school diploma or GED required; associate's or bachelor's degree in healthcare administration, business, or related field preferred.
2+ years of experience in medical billing, with a focus on behavioral health.
- Strong knowledge of Medicaid and commercial insurance billing requirements and guidelines.
- Familiarity with multiple levels of care, including residential PHP, IOP, and outpatient.
- Proficiency with medical billing software.
- Strong understanding of medical coding.
- Ability to research and resolve complex billing issues and payer denials.
- Excellent attention to detail, analytical skills, and problem-solving ability.
- Strong communication skills and the ability to work effectively with both internal and external stakeholders.
- Knowledge of HIPAA compliance and confidentiality standards
Wisconsin’s Premier Addiction Treatment Center Serving Individuals and Families in Milwaukee and Waukesha
At WisHope Recovery Center, our mission is to offer holistic, evidence-based and individualized addiction treatment and recovery solutions for individuals in Wisconsin who are seeking recovery for substance use and co-occurring mental health disorders.
Our vision at WisHope Recovery Center is to foster hope and healing by providing an individualized approach and a continuum of care that supports the whole person – the mind, the body and the soul.
WisHope Recovery Center was founded in 2016 by Peter Brunzelle. Peter is WisHope Recovery’s Executive Director and serves on the Waukesha County Heroin Task Force Board. He also serves as president of the Wisconsin Association of Sober Housing (WASH), a nonprofit organization that establishes standards and quality assurance in recovery housing and affiliates for the state of Wisconsin. He is also a person in long-term recovery.
WisHope Recovery Center (WRC) was founded because of the gap in integrated substance use and mental health treatment services available in Wisconsin. “There wasn’t a place where one could go for treatment that supported multiple pathways to recovery,” Brunzelle says. “If you needed support for psychiatric medication, medicated-assisted treatment, or were dealing with co-occurring disorders you were not accepted at most treatment centers. It really was a one size fits all approach across the state. This is why I created WRC. Not only do we support all pathways to recovery, but we integrate family programming into our treatment approach. We understand that including loved ones in one’s recovery journey from the start is critical as this allows for consistency and enhanced healing. When clients leave our program, they’ve already worked hard to repair and improve their support systems, which makes it easier for them to rebuild their lives when they are ready to move onto the next chapter.”
Join Our Team Form - WisHope Recovery Center
Are you an experienced treatment professional or a person in recovery passionate about giving back and helping others through peer support? If so, you’ve come to the right place. WisHope Recovery Center is Wisonconsin’s Premier Addiction Treatment Center, which means we only hire the best of the best so we can continue to improve the lives of those impacted by substance use and co-occurring mental health conditions.
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