Behavioral Health Billing & Follow-Up Specialist - 139042

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team committed to quality, collaboration, and continuous improvement.

The Patient Biller III - Behavioral Health Billing & Follow-Up Specialist is responsible for complex hospital billing and follow-up activities with a primary focus on Behavioral Health (BH) services, including inpatient psychiatric and outpatient behavioral health claims.

This role performs advanced billing, follow-up, denial resolution, and account reconciliation functions for behavioral health accounts. Responsibilities include resolving payer denials, identifying root causes, coordinating with clinical and authorization teams, and ensuring compliance with payer contracts and regulatory requirements specific to behavioral health services.

The position requires expertise in payer carve-outs, mental health benefit structures, authorization requirements, and medical necessity criteria related to behavioral health services.

KEY RESPONSIBILITIES:

• Perform billing and follow-up for Behavioral Health (IP Psych and OP BH) accounts
• Resolve complex denials including: No authorization / late authorization, Medical necessity denials (psych criteria), Benefit misclassification (medical vs behavioral health)
• Interpret payer contracts and behavioral health carve-out arrangements
• Coordinate with: Clinical RNs (for medical necessity appeals-related to medical services only), Patient Access / Authorization teams, Denials Management (related to BH/Psych), Credit/Refund Team
• Submit and track appeals through payer portals and correspondence workflows
• Identify trends and escalate systemic issues (e.g., auth gaps, payer processing errors)
• Ensure compliance with: State and Federal regulations, Behavioral health billing guidelines
• Process adjustments, refunds, and credit balances as appropriate
• Maintain productivity and quality standards at an expert level

• Three (3) years of recent acute care hospital billing and collection experience.
• Strong knowledge of medical insurance and State/Federal billing regulations.
• Experience with Behavioral Health billing.
• Experience with insurance claim appeals and denial resolution.
• Knowledge of ICD-10, CPT, HCPCS coding principles.
• Knowledge of UB-04 billing and revenue codes.
• Understanding of payer reimbursement methodologies (DRG, per diem, case rate, fee schedule).

• Behavioral Health / Psychiatric billing experience.
• Experience with: Mental health payer carve-outs, Authorization workflows for psychiatric admissions, and/or Medical necessity criteria (MCG, InterQual, or payer-specific).
• Epic Resolute experience.
• Experience with payer portals (Availity, etc.).
• Prior hospital credit balance/refund experience.
• Strong analytical and problem-solving skills in denial resolution.

• Employment is subject to a criminal background check and pre-employment physical.
• Must be able to work various hours and locations based on business needs.