Freelance Remote Risk Adjustment Coder Jobs in Toledo, OH

Position Overview

We are seeking a detail-oriented and experienced Billing Specialist to join our inclusive and affirming mental health practice. This position is essential to maintaining a smooth revenue cycle through accurate claims processing, efficient billing operations, and proactive communication with payers and clients. The ideal candidate will have a strong understanding of mental health billing procedures, including Ohio Medicaid, and will be comfortable working independently in a remote setting.

Key Responsibilities

Claims Processing & Revenue Cycle Management

• Correct and submit unbilled claims due to missing diagnostic codes, signatures, or pending statuses.
• Monitor claim status and follow up on rejections or denials; resubmit and appeal as needed.
• Contact payers regarding overpayments, underpayments, and recoupments within 30 days of identification.
• Process insurance write-offs for issues such as duplicates or payer errors.
• Update and maintain billing rules with the Revenue Cycle Management (RCM) vendor to improve billing efficiency.

Client Billing & Accounts Management

• Ensure client demographic and insurance information is accurate and current in the EHR system.
• Perform monthly insurance verifications for active clients.
• Address client billing inquiries professionally and provide timely resolution.
• Manage accounts receivable and support collections activity as needed.
• Maintain accurate billing logs, internal billing notes, and documentation in compliance with agency policies.

Collaboration & Compliance

• Collaborate with clinical staff to ensure documentation and coding support timely and accurate billing.
• Ensure compliance with Ohio Administrative Code (OAC), Ohio Revised Code (ORC), Medicaid requirements, and HIPAA standards.
• Stay informed of Ohio Medicaid policy updates and implement necessary billing adjustments.
• Support financial audits, compliance checks, and credentialing-related billing reviews.

Reporting & System Management

• Utilize ClinicTracker (EHR) to process claims and track financial data.
• Generate, review, and submit regular reports to monitor revenue performance and billing trends.

Credentialing & Provider Enrollment

• Assist with credentialing individual providers with Ohio Medicaid and private insurance carriers.
• Track and maintain credentialing application statuses, revalidations, and renewals.
• Collaborate with providers and administrative staff to ensure timely submission of credentialing paperwork.
• Maintain accurate records of credentialing documentation in compliance with payer and regulatory requirements.
• Communicate with carriers to resolve credentialing or enrollment-related issues affecting billing or reimbursement.

Qualifications

• Minimum 2 years of experience in medical billing, preferably in behavioral health or mental health services.
• Strong understanding of Ohio Medicaid billing guidelines and third-party insurance claim processes.
• Proficiency in EHR systems such as ClinicTracker, CareLogic, or inSync
• Working knowledge of CPT/ICD-10 coding, insurance authorization, and HIPAA compliance.
• Excellent communication and interpersonal skills.
• High level of accuracy, attention to detail, and ability to meet deadlines.
• Comfortable using inclusive, affirming, and culturally responsive language.
• Must meet all privacy and security requirements for remote work.