Medical Biller & Coder - Behavioral Health PHP/IOP (Substance Use Disorder Treatment)

The Medical Biller & Coder will be responsible for managing all aspects of behavioral health billing and coding, including claim submission, payment posting, denial management, insurance verification, prior authorizations, and reimbursement tracking. The ideal candidate will have experience with behavioral health services, commercial insurance, Medicaid/MassHealth, and electronic health record systems.

Key ResponsibilitiesMedical Billing

• Submit accurate and timely claims to commercial and government payers.
• Monitor claim status and resolve billing issues promptly.
• Post insurance and patient payments.
• Reconcile accounts receivable and follow up on unpaid claims.
• Manage claim corrections, appeals, and resubmissions.
• Review remittance advice (ERA/EOB) and identify payment discrepancies.
• Track outstanding balances and maintain billing reports.

Medical Coding

• Assign and review appropriate CPT, HCPCS, and ICD-10 codes.
• Ensure compliance with payer-specific billing requirements.
• Verify documentation supports billed services.
• Stay current on coding regulations and reimbursement updates.
• Assist clinical staff with documentation and coding guidance.

Revenue Cycle Management

• Monitor aging reports and collections.
• Investigate denials and implement corrective actions.
• Assist with insurance credentialing and payer enrollment as needed.
• Generate monthly billing and reimbursement reports.
• Collaborate with leadership to improve revenue cycle performance.

Insurance & Authorizations

• Verify patient benefits and eligibility.
• Obtain and track authorizations when required.
• Communicate with insurance companies regarding claims, denials, and coverage issues.
• Maintain knowledge of MassHealth, Medicaid Managed Care, Medicare, BCBS, Aetna, Harvard Pilgrim, Fallon, Tufts, CCA, Optum, and other payers.

• Minimum 2 years of medical billing and coding experience.
• Knowledge of CPT, HCPCS, and ICD-10 coding.
• Experience with insurance claim submission and denial management.
• Strong understanding of healthcare reimbursement processes.
• Excellent attention to detail and organizational skills.
• Proficiency with Microsoft Excel and billing software.
• Ability to work independently and manage multiple priorities.

Preferred

• Experience in behavioral health, substance use treatment, or mental health services.
• Familiarity with MassHealth and Massachusetts commercial payers.
• Experience with Kipu, Inovalon, or similar EHR/billing platforms.
• CPC, CBCS, CCS, or equivalent certification.
• Knowledge of PHP, IOP, outpatient behavioral health, and medication management billing.

Pay: $26.13 - $31.47 per hour

Pax Healing is seeking an experienced Medical Biller & Coder to join our internal team. This position is intended for an individual employee who will work directly with our organization.

Please Note: We are not seeking proposals from third-party billing companies, consultants, agencies, or outsourced revenue cycle management firms. Applications from billing companies and service providers will not be considered.

About Pax Healing

Pax Healing is a growing behavioral health organization specializing in substance use disorder and co-occurring mental health treatment. We provide a full continuum of outpatient services, including Full Day Programming, Intensive Outpatient Programs (IOP), Outpatient Therapy, Medication Management, and Case Management. Our mission is to provide compassionate, evidence-based care while helping individuals build lasting recovery.