Medical Billing Specialist - Behavioral Health / Private Insurance (Houston)

JTL is seeking a detail-oriented Behavioral Health Medicaid / Private Insurance Biller to support our outpatient behavioral health clinic in Houston, Texas. This role is responsible for full-cycle billing for Medicaid, Texas Medicaid / TMHP, Medicaid managed care, and private insurance claims.

The ideal candidate understands behavioral health revenue cycle workflows, clean claim submission, payer follow-up, prior authorization tracking, denial management, ERA/EOB reconciliation, and compliance-sensitive documentation. This position works closely with clinical, intake, and administrative teams to ensure that services are billed accurately, supported by documentation, and reimbursed in a timely manner.

This is a strong opportunity for a billing professional who enjoys solving payer issues, improving claims performance, and supporting accessible outpatient mental health care.

Key Responsibilities

Full-Cycle Billing

- Complete full-cycle billing for Texas Medicaid, Medicaid managed care, and private/commercial insurance for outpatient behavioral health services.
- Apply appropriate ICD-10 diagnosis pairing, modifiers, place of service, payer rules, and documentation requirements.
- Submit clean claims through clearinghouses, payer portals, EDI formats, and CMS-1500 when applicable.
- Monitor claim acceptance, payer rejections, front-end edits, and corrected claim needs.

Payment Posting, Reconciliation, and A/R

- Post payments and reconcile ERA/EOB remittances.
- Track unpaid, denied, rejected, underpaid, and partially paid claims.
- Work A/R aging reports and perform regular claim status checks.
- Research and resolve denials, appeals, recoupments, takebacks, and payment discrepancies.
- Communicate with payers regarding claim status, authorization issues, benefit limits, and reimbursement concerns.
- Prepare corrected claims, reconsiderations, and appeals with supporting documentation.

Prior Authorizations

- Coordinate prior authorizations for PHP and outpatient mental health services.
- Submit and track authorization requests through payer portals, TMHP PA on the Portal, fax, or other payer-required channels.
- Collect required clinical documentation from providers, including diagnosis, medical necessity support, requested units, service dates, and provider information.
- Track authorization start dates, end dates, approved units, expirations, and extension needs.
- Communicate authorization status to clinicians, schedulers, intake staff, and leadership.

Eligibility, Benefits, and Patient Support

- Verify patient eligibility, behavioral health benefits, copays, coinsurance, deductibles, visit limits, and authorization requirements.
- Review Medicaid, Medicaid managed care, and commercial insurance coverage prior to billing.
- Support patient billing inquiries with professionalism, accuracy, and empathy.
- Coordinate patient balances, payment plans, and billing questions with the appropriate team members.
- Communicate coverage or billing issues to clinical and administrative staff in a timely manner.

Compliance and Audit Readiness

- Maintain billing workflows that support HIPAA, payer policy compliance, audit readiness, and documentation sufficiency.
- Help ensure claims are supported by medical necessity documentation, session times, service dates, provider credentials, diagnosis codes, treatment plans, and clinical notes.
- Stay current on payer updates, TMHP guidance, NCCI/MUE edits, Medicaid billing rules, and private insurance requirements.
- Identify documentation gaps before claim submission and escalate issues to clinical or administrative leadership.
- Support internal billing audits, payer audits, retrospective reviews, and recoupment defense when needed.

Required Qualifications

- 2+ years of medical billing, healthcare billing, or revenue cycle experience.
- Experience with Medicaid billing; Texas Medicaid / TMHP experience strongly preferred.
- Knowledge of behavioral health billing, outpatient mental health billing, or therapy billing preferred.
- Familiarity with private insurance, Medicaid managed care, prior authorizations, denials, appeals, and payer follow-up.
- Working knowledge of CPT, HCPCS, ICD-10, CMS-1500, EDI claims, ERA/EOB reconciliation, and A/R workflows.
- Experience using EHR, EMR, or practice management systems.
- Strong attention to detail, organization, and follow-through.
- Ability to communicate professionally with payers, patients, providers, and internal team members.
- Understanding of HIPAA and patient confidentiality requirements.

Preferred Skills

- Behavioral health billing experience with outpatient therapy, crisis intervention, PHP, IOP, SUD, or community mental health programs.
- Experience with TMHP, Availity, Change Healthcare, or similar clearinghouses and payer portals.
- Experience with EHR or practice management systems such as similar platforms.
- Billing or coding certification such as CPB, CPC, CBCS, CMRS, or related credential.
- Bilingual English/Spanish is a plus for the Houston patient population.
- Strong Excel and reporting skills, including A/R aging, claims tracking, and denial trend analysis.
- Experience supporting provider credentialing, payer enrollment, CAQH updates, or provider profile maintenance.

ATS Keywords

Medicaid billing, Texas Medicaid, TMHP, behavioral health billing, private insurance, full-cycle revenue cycle, CPT, HCPCS, ICD-10, CMS-1500, EDI claims, ERA reconciliation, EOB reconciliation, denial management, appeals, accounts receivable, A/R aging, prior authorization, PHP, IOP, outpatient mental health, crisis intervention, payer inquiries, eligibility verification, benefits verification, medical billing, HIPAA, compliance, audit readiness.

What We Offer

- Competitive pay based on experience
- Medical, dental, and vision insurance.
- Professional development and billing certification support.
- Supportive, mission-driven team environment.
- Opportunity to grow into senior revenue cycle, billing lead, or supervisory responsibilities.

Schedule and Work Location

- Location: Houston, Texas
- Work setting: Outpatient behavioral health clinic
- Schedule: Part-time, Monday through Friday
- Work arrangement: On-site/hybrid optional

Equal Opportunity Statement

JTL is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by federal, state, or local law.