Turning Winds

We are seeking an expert Insurance Billing Manager to lead the revenue cycle operations for our adolescent residential treatment center. This is a specialized role focused on primary mental health, requiring a professional who can bridge the gap between clinical documentation and financial reimbursement. You will be responsible for everything from initial intake verification to defending medical necessity during peer-to-peer reviews.

Key Responsibilities

• Verification of Benefits (VOB): Lead the intake financial process by managing all VOBs for incoming admissions, ensuring clear communication of coverage to both families and clinical staff.
• Utilization Review (UR) Leadership: Schedule and manage the UR process, including preparing documentation for and facilitating peer-to-peer and doc-to-doc reviews to secure authorizations for long-term residential care.
• Full-Cycle Claims Management: Process all claims accurately using behavioral health "H-codes" and perform aggressive, timely follow-ups to ensure expedient reimbursements.
• Platform Administration: Manage and optimize our billing and EHR platform, serving as the internal expert for system workflows and data integrity.
• A/R & Appeals: Monitor accounts receivable and lead the appeals process for complex psychiatric denials, advocating directly with insurance medical directors.

Qualifications & Skills

• Experience: 5+ years in behavioral health billing with at least 2 years in a leadership role. Residential Treatment Center (RTC) experience is highly preferred.
• Technical Mastery: Deep understanding of primary mental health billing codes (H0017–H0019), mental health parity laws, and UR protocols.
• Software Proficiency: Proven ability to manage and troubleshoot behavioral health EHR/RCM platforms. Specifically, know how to utilize KIPU RCM.
• Communication: Exceptional ability to navigate sensitive financial conversations with families and professional "doc-to-doc" advocacy with payers.
• TriCare West: Experience in preparing and submitting claims for TriCare adolescent mental health services