Program: Information Technology / Billing

Job Type: Full-Time (40 hours per week)

Days & Hours: Monday - Friday, 8am to 5pm. Some weekend availability required.

Location(s) served: Agency wide.

Population served: New Horizons staff

Salary: $44,998 - $73,287 per year

JOB SUMMARY

The Billing Spec Supervisor oversees the planning, coordination, management, and monitoring of billing, provider credentialing, Medicaid enrollment, site revalidation, and revenue cycle functions supporting Behavioral Health and Developmental Disabilities services, including Georgia Medicaid, DBHDD-funded programs, waiver services, and State of Georgia-funded services.

This position is responsible for preparing and distributing invoices, managing third-party payer relationships, preparing and submitting claims, posting cash receipts, reconciling accounts, analyzing complex billing data, and producing revenue, expense, operational, and statistical reports. The incumbent ensures providers and service locations remain credentialed, enrolled, revalidated, and eligible for reimbursement while maintaining compliance with DBHDD, Georgia Medicaid, CMS, HIPAA, and organizational requirements.

Although classified as a supervisory-level position, this role functions primarily as a lead coordinator and subject matter expert without direct supervisory responsibility. The position requires extensive collaboration with Utilization Management, Operations, Clinical Services, Finance, Human Resources, Compliance, CareLogic Support, Inovalon, DBHDD, Georgia Medicaid, managed care organizations, and other stakeholders to ensure successful billing, reimbursement, credentialing, enrollment, and compliance operations.

Essential Duties & Responsibilities

Billing & Revue Cycle Management

• Oversee billing operations for DBHDD-funded Behavioral Health and Developmental Disabilities services, Georgia Medicaid programs, waiver programs, state-funded services, and third-party payers.
• Prepare, review, and submit electronic claims utilizing 837 Professional and Institutional claim formats.
• Review and reconcile 835 Electronic Remittance Advice (ERA) transactions to ensure accurate payment posting and reimbursement tracking.
• Manage Electronic Data Interchange (EDI) processes including claim transmission, remittance processing, and clearinghouse communications.
• Maintain working knowledge of EDI file layouts including:
  • 837 Professional Claims
  • 837 Institutional Claims
  • 835 Electronic Remittance Advice (ERA)
  • Clearinghouse Submission and Reconciliation Processes
• Monitor claim rejections, denials, pending claims, and suspended claims to ensure timely investigation and resolution.
• Review and work current-week denials and rejections to identify root causes and implement corrective actions.
• Maintain a departmental goal of achieving and sustaining a 95% or greater clean claim rate.
• Coordinate denial prevention initiatives with Utilization Management, Clinical Services, Operations, and providers.
• Manage claim denials, claim rejections, appeals, reconsiderations, error corrections, adjustments, refunds, and reimbursement recovery activities.
• Analyze payer edits, denial trends, and rejection patterns and implement workflow improvements.
• Ensure claims comply with DBHDD, Georgia Medicaid, CMS, HIPAA, and payer-specific billing requirements.
• Monitor prior authorizations and service utilization requirements to reduce denials and reimbursement delays.
• Oversee accounts receivable activities and aging reports.
• Post and reconcile cash receipts, electronic payments, adjustments, and remittance transactions.
• Maintain billing records and supporting documentation for audit readiness and regulatory compliance.

Provider Credentialing & Enrollment

• Manage initial credentialing, recredentialing, and payer enrollment activities for licensed and non-licensed providers.
• Coordinate onboarding credentialing requirements for new providers and clinical staff.
• Maintain provider credentialing files and supporting documentation.
• Monitor provider licenses, certifications, NPI records, and credentialing expiration dates.
• Ensure providers maintain active participation status with Georgia Medicaid, DBHDD, managed care organizations, and other payers.
• Submit provider enrollment applications, updates, terminations, ownership changes, and maintenance requests.
• Monitor credentialing timeliness to prevent interruptions in provider billing privileges.
• Serve as the primary point of contact for credentialing audits and inquiries.

Medicaid Site Enrollment & Revalidation

• Oversee Medicaid site enrollment activities for all organizational service locations.
• Manage Medicaid site revalidation processes and deadlines.
• Prepare and submit site enrollment applications, revalidations, ownership updates, and service-location changes.
• Coordinate documentation requirements with executive leadership, compliance, and operational departments.
• Maintain records of approvals, renewals, corrective actions, and correspondence with Medicaid and regulatory entities.
• Ensure all service locations maintain compliance with Georgia Medicaid participation requirements.
• Monitor enrollment status and proactively address issues that could impact reimbursement eligibility.

Compliance & Regulatory Oversight

• Ensure compliance with:
  • DBHDD Provider Manuals
  • Georgia Medicaid Policies and Procedures
  • CMS Regulations
  • HIPAA Regulations
  • Federal and State Healthcare Regulations
  • State-funded Behavioral Health Program Requirements
• Conduct internal billing, credentialing, enrollment, and compliance reviews.
• Identify reimbursement risks and compliance concerns and implement corrective actions.
• Support external audits, payer reviews, state surveys, and accreditation activities.
• Maintain documentation supporting regulatory compliance and audit readiness.
• Monitor regulatory updates impacting billing, credentialing, enrollment, and reimbursement operations.

Coordination, Oversight & Cross-Functional Collaboration

• Coordinate activities with Utilization Management, Operations, Clinical Services, Finance, Human Resources, Quality Assurance, Compliance, and Executive Leadership.
• Collaborate with CareLogic Support, Inovalon, clearinghouses, Georgia Medicaid, DBHDD, managed care organizations, and payer representatives.
• Submit, monitor, escalate, and resolve support tickets related to:
  • Billing issues
  • Claims processing
  • EDI transactions
  • Provider enrollment
  • Credentialing
  • Remittance discrepancies
  • Authorization concerns
  • CareLogic system functionality
  • Inovalon system functionality
• Coordinate with Utilization Management to resolve authorization-related denials and reimbursement issues.
• Work closely with Operations and Clinical teams to correct documentation deficiencies impacting reimbursement.
• Monitor workflow effectiveness and identify barriers affecting revenue cycle performance.
• Facilitate communication between providers, operational departments, regulatory agencies, and payers.
• Assist leadership in implementing operational improvements and corrective action plans.
• Develop, maintain, and improve billing, enrollment, credentialing, and compliance procedures.
• Support organizational readiness for audits, surveys, and regulatory inspections.

Financial Reporting & Analysis

• Analyze complex billing, reimbursement, denial, rejection, and financial data.
• Prepare monthly and ad hoc reports related to:
  • Revenue
  • Expenses
  • Accounts Receivable
  • Claims Submitted
  • Clean Claim Rates
  • Claim Denials
  • Claim Rejections
  • Appeals and Reconsiderations
  • Reimbursement Trends
  • Credentialing Status
  • Provider Enrollment Status
  • Site Revalidation Status
  • Operational Metrics
  • Statistical Data
• Monitor key performance indicators including:
  • Denial Rates
  • Rejection Rates
  • Accounts Receivable Aging
  • Clean Claim Rates
  • Reimbursement Timeliness
  • Enrollment and Credentialing Completion Rates
• Identify revenue opportunities and recommend process improvements that increase operational efficiency and reimbursement outcomes.

Minimum Qualifications:

Associate's degree in one of the following: Health Information Management, Health Informatics, Medical Billing and Coding, Healthcare Administration, Accounting, Finance, or a related field. At least five (5) years of progressively responsible experience in healthcare billing, revenue cycle management, provider credentialing, reimbursement, or healthcare financial operations, including experience with Medicaid billing, managed care organizations, electronic health record systems, and healthcare reimbursement platforms. Must be able to manage multiple projects, regulatory deadlines, payer requirements, and compliance activities. 

Preferred Qualifications:

Bachelor's degree. Professional certification in billing, coding, helath information management, credentialing, or revenue cycle management (e.g.: CPB, CPC, CCS, RHIT, RHIA, CPCS, or CRCR). 

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New Horizons Behavioral Health is an Equal Opportunity Employer and does not discriminate on the basis of color, race, national origin, age sex, religion, or disability. Selected applicants must pass a pre-employment background investigation and a pre-employment drug screen. Employment is contingent upon passing the background check and the drug screen.

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Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. We are also unable to contact applicants who are not selected for a position. All qualified applicants will be considered but may not necessarily receive an interview. Selected applicants will be contacted by Human Resources to continue the hiring process. This position is subject to close at any time once a satisfactory applicant pool has been identified.