Billing and Benefits Coordinator

Position Enrollment and Benefits Coordinator

Status

Full Time, Exempt

Reports to

Director of Integrated Care

Job Summary

The Community Mental Health (CMH) Enrollment and Benefits Coordinator is responsible for managing client-facing benefit and enrollment processes within a behavioral health setting. This role ensures that individuals in the community receive or maintain access to essential mental health services by navigating the complexities of insurance, government assistance, and other benefit programs. Candidates must have expertise in insurance billing, eligibility verification, and claims correction. These roles typically require knowledge of payer systems (e.g., Medicare, Medicaid, commercial insurers), eligibility checks, and remediation of denied or erroneous claims.

Primary Duties And Responsibilities

• Verify patient insurance eligibility and benefits prior to services, ensuring accurate documentation in the system.
• Process insurance enrollments, updates, and authorizations to support timely and accurate billing.
• Communicate with patients to explain coverage, co-pays, deductibles, and out-of-pocket responsibilities.
• Remain current on mental health services, Medicaid, and other state and federal benefit programs, including specific product options like QMB and SLMB.
• Help clients, and sometimes their family members, complete and submit applications for Medicaid, Social Security Income (SSI), Social Security Disability Insurance (SSDI), or the Supplemental Nutrition Assistance Program (SNAP).
• Provide support throughout the application process, including preparing appeals for denied benefits and following up with agencies like Social Security and Medicaid.
• Conduct meetings to educate clients on their insurance coverage, eligibility, and the options available to them for mental health and other community services.
• Gather, verify, and input clients' social, financial, and medical information into various applications and databases.
• Working with the Electronic Health Record (EHR) team to ensure accuracy and efficiency in billing and coding processes.
• Maintain accurate client benefits records, process enrollment changes and terminations, and track application statuses.
• Ensures claims are clean and free of errors prior to submitting to the billing department.
• Ensure benefits administration is compliant with federal and state regulations and prepare reports on Medicaid status and program efficacy.
• Audits medical record documentation to identify miscoded and under / up coded and training on accurate coding practices and compliance issues.
• Work closely with other identified clinical staff to ensure best clinical standards and coding is followed.
• Liaise between clients, families, providers, front office staff, and billing teams to resolve insurance-related issues.
• Submit and follow up on prior authorizations, referrals, and benefit inquiries with payers.
• Monitor payer portals and correspondence for updates, coverage changes, or denials.
• Educate patients about financial assistance programs or alternative payment options as needed.
• Ensure compliance with HIPAA and organizational policies in handling patient and payer information.
• Contribute to departmental goals of reducing denials, improving collections, and enhancing patient satisfaction.
• Completes all other assignments or duties as designated.

Qualifications

Preferred Certifications

Working Conditions

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