Billing & UR Specialist

Our acute adolescent care facility is seeking a dedicated Full Time Billing and Utilization Review (UR) Specialist. This position is ideal for an experienced billing professional with strong knowledge of insurance and Medicaid billing, as well as experience with Utilization Review processes in a mental health or acute care setting. This role primarily supports weekday operations but may include flexible weekend hours as needed.

The ideal candidate will be compassionate, detail-oriented, and proactive in helping patients and families navigate insurance, billing, and authorization processes.

High school diploma/GED required. Associate degree or certification in medical billing, insurance coding, or health information management strongly preferred.

• Two to three years of experience in medical billing and coding, preferably in a behavioral health or acute care setting, required.
• Knowledge of Medicaid and insurance requirements for adolescent mental health services.
• Prior experience with Utilization Review processes (authorization requests, concurrent reviews, clinical documentation coordination) preferred.
• Excellent customer service skills and phone manner.
• Strong time management and organizational skills.
• Must possess a current certificate for CPR and first aid.
• History with billing AR.

• Submit reimbursement requests to Medicare, Medicaid, and private insurance.
• Accurately process insurance claims, enter charges, and post payments in a timely manner.
• Follow up on payer denials, re-submit claims, and resolve billing discrepancies.
• Work with patients and families to develop self-pay arrangements and payment plans.
• Initiate private pay collections as needed.
• Maintain accurate and confidential billing documentation.
• Adjust patient accounts accurately according to company policies and criteria.

• Submit and track prior authorizations for treatment services.
• Coordinate and conduct concurrent reviews with insurance companies.
• Ensure that clinical documentation supports medical necessity.
• Communicate authorization updates to treatment teams.
• Assist in tracking length of stay and discharge planning from a payer perspective.
• Document all UR activities accurately and timely.

• This position requires availability on weekdays and may include some flexible weekend hours.
• The candidate must be able to work independently with minimal supervision, maintaining confidentiality and professionalism at all times.
• Must have reliable transportation and the ability to work on-site.

Please include a cover letter or paragraph in your resume that explains your interest in this position as well as your interest and experience with billing, utilization review, and healthcare. Please provide 3 professional references.