About the Role
We are seeking a Certified Medical Coder with a strong background in behavioral health coding and billing to ensure accurate and compliant documentation for services rendered, such as PHP (Partial Hospitalization Program) and IOP (Intensive Outpatient Program). The ideal candidate will have hands-on experience working with CPT, HCPCS, and revenue codes, and will collaborate closely with providers, the internal billing department, and payer representatives.
This role is crucial in supporting billing integrity, addressing coding discrepancies, managing daily volumes (e.g., 30+ patients), and staying on top of evolving payer requirements.
Key Responsibilities
- Review and assign CPT, HCPCS, and revenue codes for behavioral health services (e.g., PHP, IOP) ensuring accuracy and payer compliance.
- Validate clinical documentation to support coded services and prevent duplicate billing.
- Audit code usage for onboarding patients, attendance records, and service-level documentation.
- Collaborate with billing team, nurse practitioners, and therapists to ensure clean claims submission.
- Monitor coding volume (e.g., 30+ patients per day), address backlogs, and maintain real-time documentation standards.
- Follow up on EOBs (Explanation of Benefits) and payment reconciliations — identify and explain discrepancies.
- Place calls to parents or payers (e.g., Blue Cross Blue Shield) when checks are received to confirm benefit coverage, clarify payment details, and address any denial reasons.
- Communicate with clients as needed to explain the services billed and checks received.
Requirements
- Certified Professional Coder (CPC, CCS, or equivalent)
- 2+ years of coding experience, preferably in behavioral health or mental health settings
- Strong understanding of payer policies, EOBs, and insurance claims workflows
- Experience with PHP, IOP billing and service documentation
- Proficient in medical billing software and EMR systems
- Strong attention to detail, analytical mindset, and ability to work through claim discrepancies
- Comfortable making professional calls to clients and insurance companies to explain services and payment details
Preferred Skills
- Familiarity with Blue Cross Blue Shield or other major insurance payers
- Experience working within a multi-provider practice or a high-volume setting
- Knowledge of utilization review or medical necessity documentation
- Effective written and verbal communication skills for cross-departmental collaboration
Requirements
This is a full time job
100% Remote
$9-$10/hr