Medical Biller – BHRF (Behavioral Health Residential Facility)

Connexus Cure, located in Gulberg, Lahore, is seeking an experienced Medical Biller with specialized expertise in Behavioral Health Residential Facilities (BHRF) to join their full-time, on-site team. The ideal candidate will have practical experience in U.S. healthcare billing, focusing on behavioral health residential treatment facilities, insurance claims processing, denial management, and accounts receivable follow-up. A thorough understanding of BHRF billing workflows, payer requirements, authorization management, and reimbursement processes for U.S.-based behavioral health facilities is essential. Candidates with direct experience handling BHRF claims for U.S. insurance payers, including Medicaid and commercial insurance plans, will be highly preferred.

Key Responsibilities
- BHRF Medical Billing: Oversee billing operations for Behavioral Health Residential Facilities, ensuring claims are reviewed and submitted according to payer-specific guidelines.
- Claims Submission: Prepare and submit accurate electronic and paper claims, applying appropriate procedure codes, revenue codes, modifiers, and billing details.
- Insurance Verification: Verify patient eligibility, benefits, coverage limitations, and behavioral health treatment benefits.
- Authorization Management: Monitor prior authorizations, continued-stay approvals, and authorization limits to reduce claim denials.
- Denial Management: Investigate and resolve denied or rejected BHRF claims related to authorization, eligibility, or documentation issues.
- Accounts Receivable (AR) Follow-Up: Communicate with insurance companies to pursue unpaid or underpaid claims and ensure timely reimbursement.
- Payment Posting: Accurately post insurance payments, adjustments, and contractual write-offs while reconciling discrepancies.
- Payer Portal Management: Utilize insurance portals and clearinghouses to check claim status, submit claims, review remittance advice, and manage payer correspondence.
- Behavioral Health Coding Knowledge: Apply knowledge of BHRF-related billing codes, including HCPCS codes such as H0018, based on payer, service definitions, contracts, and billing requirements.
- Documentation Review: Collaborate with facility and clinical teams to obtain necessary documentation and resolve billing discrepancies.
- Reporting: Maintain detailed billing records and generate regular reports on AR aging, claim status, denials, collections, and reimbursement performance.
- Compliance: Adhere to U.S. healthcare billing regulations, payer policies, HIPAA requirements, and internal billing procedures.

Required Qualifications
- Proven experience in U.S. medical billing, specifically with Behavioral Health Residential Facility billing.
- Strong knowledge of Medicaid and commercial insurance billing workflows.
- Skilled in claims submission, payment posting, denial resolution, and AR follow-up.
- Familiarity with behavioral health billing codes, authorization processes, and payer-specific billing guidelines.
- Experience using medical billing software, EHR/EMR systems, clearinghouses, and insurance payer portals.
- Excellent analytical, communication, and problem-solving abilities.
- Ability to work independently, manage multiple facility accounts, and meet deadlines.
- Proficient written and spoken English for effective communication with U.S. insurance companies and healthcare clients.

Preferred Experience and Benefits
- Experience working directly with U.S. BHRF facilities and their Medicaid managed care or commercial insurance plans is highly desirable.
- Competitive salary starting from Rs120,000 per month, commensurate with experience and technical expertise.
- Professional work environment based in Gulberg, Lahore.
- Opportunity to collaborate with U.S.-based healthcare facilities.
- Career advancement prospects within medical billing and revenue cycle management.
- Performance-based incentives where applicable.

This position requires working on-site at the Gulberg office. Candidates are encouraged to apply by submitting an updated CV that highlights specific BHRF billing experience, years of experience, U.S. payers handled, billing software proficiency, and experience with residential behavioral health claims.