Billing Specialist Supervisor

Full-time position (40 hours per week), Monday–Friday, 8 am–5 pm. Some weekend availability required. Agency-wide role serving New Horizons staff.

About the role

The Billing Specialist Supervisor oversees planning, coordination, management, and monitoring of billing, provider credentialing, Medicaid enrollment, site revalidation, and revenue-cycle functions supporting Behavioral Health and Developmental Disabilities services, including Georgia Medicaid, DBHDD-funded programs, waiver services, and State of Georgia-funded services. This position prepares and distributes invoices, manages third-party payer relationships, submits claims, posts cash receipts, reconciles accounts, analyzes complex billing data, and produces revenue, expense, operational, and statistical reports. The incumbent ensures providers and service locations remain credentialed, enrolled, revalidated, and eligible for reimbursement while maintaining compliance with DBHDD, Georgia Medicaid, CMS, HIPAA, and organizational requirements. Although classified as supervisory, this role functions primarily as a lead coordinator and subject-matter expert without direct supervisory responsibility. Extensive collaboration is required with Utilization Management, Operations, Clinical Services, Finance, Human Resources, Compliance, CareLogic Support, Inovalon, DBHDD, Georgia Medicaid, managed-care organizations, and other stakeholders.

Responsibilities

• Oversee billing operations for DBHDD-funded Behavioral Health and Developmental Disabilities services, Georgia Medicaid programs, waiver programs, state-funded services, and third-party payers.
• Prepare, review, and submit electronic claims using 837 Professional and Institutional claim formats.
• Review and reconcile 835 Electronic Remittance Advice (ERA) transactions to ensure accurate payment posting and reimbursement tracking.
• Manage Electronic Data Interchange (EDI) processes including claim transmission, remittance processing, and clearinghouse communications.
• Maintain working knowledge of EDI file layouts: 837 Professional Claims, 837 Institutional Claims, 835 ERA, and clearinghouse submission/reconciliation processes.
• Monitor claim rejections, denials, pending claims, and suspended claims to ensure timely investigation and resolution.
• Review and work current-week denials and rejections to identify root causes and implement corrective actions.
• Maintain a departmental goal of achieving and sustaining a 95 % or greater clean-claim rate.
• Coordinate denial-prevention initiatives with Utilization Management, Clinical Services, Operations, and providers.
• Manage claim denials, rejections, appeals, reconsiderations, error corrections, adjustments, refunds, and reimbursement-recovery activities.
• Analyze payer edits, denial trends, and rejection patterns and implement workflow improvements.
• Ensure claims comply with DBHDD, Georgia Medicaid, CMS, HIPAA, and payer-specific billing requirements.
• Monitor prior authorizations and service-utilization requirements to reduce denials and reimbursement delays.
• Oversee accounts-receivable activities and aging reports.
• Post and reconcile cash receipts, electronic payments, adjustments, and remittance transactions.
• Maintain billing records and supporting documentation for audit readiness and regulatory compliance.
• Manage initial credentialing, recredentialing, and payer-enrollment activities for licensed and non-licensed providers.
• Coordinate onboarding credentialing requirements for new providers and clinical staff.
• Maintain provider credentialing files and supporting documentation.
• Monitor provider licenses, certifications, NPI records, and credentialing expiration dates.
• Ensure providers maintain active participation status with Georgia Medicaid, DBHDD, managed-care organizations, and other payers.
• Submit provider enrollment applications, updates, terminations, ownership changes, and maintenance requests.
• Monitor credentialing timeliness to prevent interruptions in provider billing privileges.
• Serve as the primary point of contact for credentialing audits and inquiries.
• Oversee Medicaid site-enrollment activities for all organizational service locations.
• Manage Medicaid site-revalidation processes and deadlines.
• Prepare and submit site-enrollment applications, revalidations, ownership updates, and service-location changes.
• Coordinate documentation requirements with executive leadership, compliance, and operational departments.
• Maintain records of approvals, renewals, corrective actions, and correspondence with Medicaid and regulatory entities.
• Ensure all service locations maintain compliance with Georgia Medicaid participation requirements.
• Monitor enrollment status and proactively address issues that could impact reimbursement eligibility.
• Ensure compliance with DBHDD Provider Manuals, Georgia Medicaid Policies and Procedures, CMS Regulations, HIPAA Regulations, Federal and State Healthcare Regulations, and State-funded Behavioral Health Program Requirements.
• Conduct internal billing, credentialing, enrollment, and compliance reviews.
• Identify reimbursement risks and compliance concerns and implement corrective actions.
• Support external audits, payer reviews, state surveys, and accreditation activities.
• Maintain documentation supporting regulatory compliance and audit readiness.
• Monitor regulatory updates impacting billing, credentialing, enrollment, and reimbursement operations.
• Coordinate activities with Utilization Management, Operations, Clinical Services, Finance, Human Resources, Quality Assurance, Compliance, and Executive Leadership.
• Collaborate with CareLogic Support, Inovalon, clearinghouses, Georgia Medicaid, DBHDD, managed-care organizations, and payer representatives.
• Submit, monitor, escalate, and resolve support tickets related to billing issues, claims processing, EDI transactions, provider enrollment, credentialing, remittance discrepancies, authorization concerns, and CareLogic/Inovalon system functionality.
• Coordinate with Utilization Management to resolve authorization-related denials and reimbursement issues.
• Work closely with Operations and Clinical teams to correct documentation deficiencies impacting reimbursement.
• Monitor workflow effectiveness and identify barriers affecting revenue-cycle performance.
• Facilitate communication between providers, operational departments, regulatory agencies, and payers.
• Assist leadership in implementing operational improvements and corrective-action plans.
• Develop, maintain, and improve billing, enrollment, credentialing, and compliance procedures.
• Support organizational readiness for audits, surveys, and regulatory inspections.
• Analyze complex billing, reimbursement, denial, rejection, and financial data.
• Prepare monthly and ad-hoc reports related to revenue, expenses, accounts receivable, claims submitted, clean-claim rates, claim denials, claim rejections, appeals and reconsiderations, reimbursement trends, credentialing status, provider-enrollment status, site-revalidation status, operational metrics, and statistical data.
• Monitor key performance indicators including denial rates, rejection rates, accounts-receivable aging, clean-claim rates, reimbursement timeliness, and enrollment/credentialing completion rates.
• Identify revenue opportunities and recommend process improvements that increase operational efficiency and reimbursement outcomes.

Requirements

• Associate’s degree in Health Information Management, Health Informatics, Medical Billing and Coding, Healthcare Administration, Accounting, Finance, or a related field.
• At least five years of progressively responsible experience in healthcare billing, revenue-cycle management, provider credentialing, reimbursement, or healthcare financial operations, including experience with Medicaid billing, managed-care organizations, electronic health-record systems, and healthcare reimbursement platforms.
• Ability to manage multiple projects, regulatory deadlines, payer requirements, and compliance activities.

Preferred Qualifications

• Bachelor’s degree.
• Professional certification in billing, coding, health-information management, credentialing, or revenue-cycle management (e.g., CPB, CPC, CCS, RHIT, RHIA, CPCS, or CRCR).

Pay

$44,998 – $73,287 per year.

Schedule

Monday–Friday, 8 am–5 pm. Some weekend availability required.