Psychiatry Medical Biller Spravato & TMS | Permanent WFH

We are seeking an experienced, detail-oriented, and highly independent Psychiatry Medical Biller to support a multi-location U.S.-based outpatient psychiatry practice specializing in interventional psychiatry, Spravato (esketamine) treatments, Transcranial Magnetic Stimulation (TMS), and medication management.

The ideal candidate has extensive hands-on experience in full-cycle psychiatry billing, with strong expertise in Spravato and TMS coding, payer-specific billing requirements, denial management, and insurance reimbursement.

Key Responsibilities

Medical Billing & Claims Management

• Manage end-to-end medical billing operations for outpatient psychiatry services, including Spravato, TMS, medication management, and psychiatric evaluations.
• Verify patient insurance eligibility, benefits, and coverage
• requirements before scheduled appointments.
• Obtain, monitor, and follow up on prior authorizations, particularly for TMS procedures.
• Accurately enter charges, review documentation, and submit approximately 1,000 insurance claims monthly.
• Apply appropriate CPT, HCPCS, modifiers, and payer-specific billing guidelines to ensure accurate reimbursement.
• Differentiate Medicare and commercial payer requirements, particularly for Spravato administration, observation time, and prolonged office visits.
• Ensure accurate billing for provider-purchased medications versus specialty pharmacy-supplied medications.
  
  

Payment Posting & Denial Resolution

• Process insurance payments and reconcile approximately 80 remittance files weekly.
• Investigate and resolve denied, rejected, underpaid, and outstanding claims.
• Prepare corrected claims, resubmissions, and first- and second-level appeals.
• Manage existing denial backlogs and identify recurring billing issues to prevent future revenue losses.
• Follow up with insurance carriers to resolve unpaid claims and payment discrepancies.
• Process secondary insurance claims and manage coordination of benefits (COB).
• Prepare accurate patient statements and maintain updated billing records.
  
  

Revenue Cycle Management & Collaboration

• Maintain consistent claims processing and revenue collection during the transition to an AI-powered billing platform.
• Perform manual billing activities during the initial implementation and calibration period.
• Identify coding discrepancies, reimbursement issues, and opportunities to improve claims acceptance rates.
• Coordinate with the billing team to provide regular updates on outstanding accounts, denial trends, and payment resolutions.
• Independently prioritize daily workloads and proactively address billing concerns without requiring constant supervision.
• Maintain compliance with HIPAA regulations, payer guidelines, and established revenue cycle procedures.
  
  

QualificationsOffice Visits and Prolonged ServicesPsychiatric Screening and EvaluationTranscranial Magnetic Stimulation (TMS)

• Proven hands-on experience in outpatient psychiatry medical billing, preferably involving Spravato and TMS treatments.
• Strong understanding of full-cycle revenue cycle management, including eligibility verification, authorization, charge entry, payment posting, denials, appeals, and collections.
• Extensive knowledge of the following CPT and HCPCS codes: Spravato and Interventional Psychiatry
• G2082, G2083, J0013, and 0820T
• Medicare versus commercial payer billing requirements
• Buy-and-bill versus specialty pharmacy medication billing
• 99214, 99215, 99205
• 99417 (commercial payers)
• G2212 (Medicare)
• 96127, including modifiers 25, 59, and XU as applicable
• 90837, 90833, and 90792
• 90867, 90868, and 90869
• TMS prior authorization requirements and tracking
• Demonstrated ability to resolve complex claim denials, manage secondary insurance claims, and prepare first- and second-level appeals.
• Strong understanding of payer-specific coding requirements, particularly for observation time, prolonged services, and add-on codes.
• Excellent attention to detail, analytical thinking, and problem-solving abilities.
• Strong written and verbal communication skills for effective internal collaboration.
• Ability to work independently, manage competing priorities, and take ownership of unresolved billing issues.
• At least 3 years of full-cycle behavioral health or psychiatry billing experience.
• Experience handling insurance claims for practices based in Indiana, Ohio, Kentucky, or Michigan.
• Familiarity with major U.S. insurance payers, including:
• Anthem Blue Cross and Blue Shield
• Indiana Medicaid (Gainwell and managed care plans)
• Medicare Part B, Medicare Advantage, and Medicare Supplement
• UnitedHealthcare/UMR, Cigna, Aetna, and Humana
• TRICARE and VA Community Care (Optum)
• Experience using Availity and other insurance payer portals.
• Proficiency with Jane or AdvancedMD practice management systems.
• AAPC Certified Professional Coder (CPC) or Certified Professional Biller (CPB) certification.
• Experience supporting billing transitions, clearing denial backlogs, or implementing new billing systems.
• Amenable to work during US hours
• Must be willing to undergo a background check as part of the hiring process
  

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary
  
  

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