QMHP Billing Specialist

SUMMARY:

The Billing Specialist is responsible for the accurate and timely billing of Qualified Mental Health Professional (QMHP) services, and for making sure all QMHP staff meet and maintain the credentialing requirements needed to deliver and bill those services. This position works closely with clinical staff, program leadership, and external payers to protect revenue integrity and keep the program compliant.

JOB DUTIES AND ESSENTIAL FUNCTIONS:

Billing and Revenue Cycle

• Review service documentation and verify it supports the billed service, including service type, date, duration, and provider credentials.
• Enter charges and prepare, submit, and track claims to Medicaid, managed care organizations, and other payers.
• Follow up on denied, rejected, and unpaid claims, and submit corrections and appeals within payer deadlines.
• Stay current with changes in billing codes, laws, and payer requirements.
• Post payments and adjustments and reconcile accounts.
• Verify client eligibility and authorizations and track authorization units and expiration dates.
• Prepare regular billing, denial, and accounts receivable reports for leadership.
• Identify trends in denials and documentation errors and recommend process improvements.

QMHP Credentialing and Compliance

• Maintain a current credentialing file and tracking system for every QMHP and QMHP-eligible staff member, including degrees, transcripts, licenses or registrations, supervised experience, and required training.
• Confirm each staff member's credential status before they are scheduled to provide or bill QMHP services.
• Track expiration dates, renewals, continuing education, and supervision requirements, and give staff and supervisors advance notice of upcoming deadlines.
• Coordinate with Human Resources and clinical supervisors on onboarding, primary source verification, and credential applications.
• Make sure only appropriately credentialed staff are billed as QMHPs, and flag any gaps to leadership right away.
• Keep up with changes to state, payer, and licensing board QMHP requirements, and update internal tracking and procedures to match.
• Point of contact for internal audits and external payer or state audits by assembling credentialing and billing records.

Collaboration and Communication

• Provide feedback and brief training to clinical staff on documentation and billing requirements.
• Serve as the point of contact for payers regarding billing and provider enrollment questions.
• Maintain confidentiality of client and personnel information in accordance with HIPAA and agency policy.