Billing Specialist

Job Summary

Prior Authorization

TeemaGroup

Full-time

In-Office | White Plains, NY, United States

Overview:
The Prior Authorization & Billing Specialist plays a critical role in ensuring timely access to mental health services by managing insurance authorizations, billing processes, and reimbursement workflows. This position serves as a key liaison between clinical teams, insurance payers, and patients, ensuring services are authorized, accurately billed, and compliant with regulatory and payer requirements. This role is ideal for a detail-oriented professional passionate about supporting behavioral health access through strong administrative and revenue cycle expertise.


What you will be doing:
Prior Authorization & Utilization Management

• Obtain and manage prior authorizations for outpatient and inpatient mental health services, including therapy, psychiatry, psychological testing, and intensive programs.

• Review clinical documentation to ensure medical necessity and payer compliance.

• Submit authorization requests to insurance companies via portals, phone, or electronic systems.

• Track authorization approvals, denials, expirations, and extensions; proactively follow up to prevent treatment delays.

• Communicate authorization status clearly with clinicians, scheduling staff, and leadership.

• Assist with peer-to-peer reviews and appeals when authorization is denied or partially approved.

Billing & Revenue Cycle Support

• Submit accurate and timely claims for mental health services to commercial, Medicaid, and Medicare payers.

• Verify insurance eligibility, benefits, and coverage limitations prior to services.

• Review Explanation of Benefits (EOBs) and remittance advice for accuracy.

• Identify, research, and resolve claim denials, underpayments, and rejections.

• Post payments and adjustments accurately when applicable.

• Maintain compliance with CPT, ICD-10, and modifier guidelines specific to behavioral health billing.

Administrative & Compliance Responsibilities

• Maintain accurate patient authorization and billing records within electronic health record (EHR) and billing systems.

• Ensure compliance with HIPAA, payer contracts, and internal policies.

• Collaborate with clinical, administrative, and finance teams to optimize workflows and reduce revenue leakage.

• Monitor payer requirements, policy changes, and authorization rules related to mental health services.

• Prepare reports related to authorization turnaround times, denial trends, and billing performance.

• Perform other related duties as assigned.

What you must have:
Education and Experience

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or related field preferred.

• Minimum of 2 years of experience in prior authorization, utilization review, medical billing, or revenue cycle operations.

• Experience in mental health or behavioral health services strongly preferred.

Knowledge, Skills, and Abilities

• Strong understanding of prior authorization processes and insurance requirements.

• Knowledge of behavioral health billing practices, CPT and ICD-10 coding, and payer guidelines.

• Excellent attention to detail and organizational skills.

• Ability to manage multiple priorities in a fast-paced environment.

• Strong written and verbal communication skills, including professional interaction with payers and clinical staff.

• Ability to work independently while collaborating effectively with a team.

• Proficiency with EHR systems, billing software, and Microsoft Office applications.