Must have at least 2 to 3 years of SUD or Behavioral Health billing experience (IOP, PHP, OP, residential)
1. Handle full revenue cycle (RCM) for SUD services: VOB/eligibility checks, prior authorizations, charge entry, claim submission, payment posting, and denial management
2. Bill commercial PPO/HMO plans (Anthem, Blue Shield, Aetna, Cigna, UHC, Health Net) and Drug Medi-Cal through the county DMC-ODS.
3. Submit clean claims on CMS-1500 and UB-04 forms using the correct CPT, HCPCS (H-codes), revenue codes, and ICD-10-CM F-codes
3. Coordinate with UR (utilization review) on ASAM level-of-care authorizations and concurrent reviews.
4. Work EOBs/ERAs, appeals, and A/R aging reports, and keep A/R days down
5. Maintain compliance with HIPAA, 42 CFR Part 2, and payer and DHCS documentation standards.
