QMHP Billing Specialist

SUMMARY:

The Billing Specialist is responsible for the accurate and timely billing of Qualified Mental Health Professional (QMHP) services, and for making sure all QMHP staff meet and maintain the credentialing requirements needed to deliver and bill those services. This position works closely with clinical staff, program leadership, and external payers to protect revenue integrity and keep the program compliant.

JOB DUTIES AND ESSENTIAL FUNCTIONS:

Billing and Revenue Cycle

- Review service documentation and verify it supports the billed service, including service type, date, duration, and provider credentials.

- Enter charges and prepare, submit, and track claims to Medicaid, managed care organizations, and other payers.

- Follow up on denied, rejected, and unpaid claims, and submit corrections and appeals within payer deadlines.

- Stay current with changes in billing codes, laws, and payer requirements.

- Post payments and adjustments and reconcile accounts.

- Verify client eligibility and authorizations and track authorization units and expiration dates.

- Prepare regular billing, denial, and accounts receivable reports for leadership.

- Identify trends in denials and documentation errors and recommend process improvements.

QMHP Credentialing and Compliance

- Maintain a current credentialing file and tracking system for every QMHP and QMHP-eligible staff member, including degrees, transcripts, licenses or registrations, supervised experience, and required training.

- Confirm each staff member's credential status before they are scheduled to provide or bill QMHP services.

- Track expiration dates, renewals, continuing education, and supervision requirements, and give staff and supervisors advance notice of upcoming deadlines.

- Coordinate with Human Resources and clinical supervisors on onboarding, primary source verification, and credential applications.

- Make sure only appropriately credentialed staff are billed as QMHPs, and flag any gaps to leadership right away.

- Keep up with changes to state, payer, and licensing board QMHP requirements, and update internal tracking and procedures to match.

- Point of contact for internal audits and external payer or state audits by assembling credentialing and billing records.

Collaboration and Communication

- Provide feedback and brief training to clinical staff on documentation and billing requirements.

- Serve as the point of contact for payers regarding billing and provider enrollment questions.

- Maintain confidentiality of client and personnel information in accordance with HIPAA and agency policy.

Qualifications

MINIMUM REQUIREMENTS:

- High school diploma or equivalent; associate degree or relevant coursework preferred.

- Two years of experience in behavioral health billing.

- Experience and has working knowledge of Medicaid and managed care billing, CPT/HCPCS coding, prior authorization processes, and claim denial resolution.

- Strong attention to detail and organizational skills, with the ability to manage multiple deadlines.

- Proficiency with electronic health record and billing software, and with Excel or similar tools.

- Ability to maintain confidentiality and work within HIPAA requirements.

- Understanding of behavioral health service documentation standards

- Clear written and verbal communication

- Ability to work independently and collaboratively

- Sound judgment in handling sensitive and compliance-related matters

PREFERRED REQUIREMENTS:

- Experience with QMHP billing.

- Experience tracking provider credentialing or enrollment.

- Billing or coding certification (e.g., CPC, CMRS).

- Familiarity with state-specific QMHP definitions and requirements.

WORKING CONDITIONS:

- Operate primarily in a fast-paced, collaborative workflow requiring the ability to shift between relationship development, educational delivery, outreach activity, follow-up, and organizational priorities.

- Regular, punctual attendance is essential for maintaining effective internal and external relationships.

PHYSICAL DEMANDS:

- Prolonged periods of sitting while working at a desk and using a computer.

Equal Employment Opportunity Statement

Gladney Center for Adoption is an equal opportunity employer committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status. All qualified applicants will receive consideration for employment without regard to these factors. We encourage applications from individuals of all backgrounds and experiences.