Billing & Credentialing Specialist

Billing & Credentialing Specialist at Canopy Roots + Canopy Mental Health & Consulting As our Billing & Credentialing Specialist, you will lead end-to-end billing operations and own provider credentialing across behavioral health programs, with a strong emphasis on Minnesota Medicaid (MHCP), Medicare, and commercial payer requirements. This role is critical to maintaining healthy revenue cycles, compliant billing practices, and accurate payer relationships in a mental health setting. You will collaborate closely with finance, clinical, and People Ops teams to monitor accounts receivable, manage payer relationships, ensure compliance with evolving billing rules, and support clients with clarity and compassion. Job Details Start Date: ASAP Location: Hybrid Remote (U.S/MN.-based) – Preference for candidates located in Minnesota or with strong knowledge of Minnesota Medicaid (MHCP) Hiring Pay Range:$26.00/hour - $33.00/hour Hours/Day: Monday–Friday, 9:00am-5:30pm CST Job Type: Full-Time Key Responsibilities Behavioral Health Billing & Revenue Cycle Management Manage full-cycle billing for mental health services, including claim submission, payment posting, and reconciliation. Verify eligibility and benefits, obtain prior authorizations, and ensure accurate and timely claim submission. Audit claims against clinical documentation to ensure compliance with CPT/ICD-10 behavioral health coding standards. Conduct denial management, including research, corrected claims, and appeals with supporting clinical documentation. Maintain compliance with payer-specific rules, including MHCP (Minnesota Medicaid), Medicare, and commercial payers. Minnesota Medicaid (MHCP) & Payer Expertise Demonstrate strong working knowledge of MHCP billing requirements , including covered services, modifiers, documentation standards, and authorization rules. Ensure compliance with state-specific requirements such as interpreter service obligations and provider responsibilities. Stay current on Minnesota and federal regulatory updates impacting behavioral health billing. Accounts Receivable (AR) Management Monitor AR aging and proactively pursue collections through payer and client follow-up. Partner with finance to prioritize AR recovery and support cash flow planning. Track and report KPIs such as days in AR, denial rates, and net collection rate. Recommend and implement process improvements to reduce denials and improve reimbursement timelines. Credentialing & Enrollment (Behavioral Health Focus) Manage end-to-end credentialing and re-credentialing for providers across: Medicaid (including MHCP) Medicare Commercial payers (e.g., UHC, BCBS, Aetna) Maintain and update CAQH profiles and payer portals. Track credentialing timelines, expirations, and revalidation requirements. Maintain provider rosters, contracts, and fee schedules. Coordinate with leadership on payer enrollment strategies and reimbursement updates. Authorization & Utilization Management Submit and track prior authorizations for behavioral health services. Monitor utilization limits and ensure services align with authorized units and treatment plans. Collaborate with clinicians to resolve authorization and documentation issues. Compliance & Audit Readiness Ensure compliance with HIPAA, Medicaid/Medicare regulations, and behavioral health documentation standards. Maintain audit-ready documentation and support internal/external audits. Monitor regulatory and payer policy updates and translate them into operational changes. Client & Team Communication Serve as a primary point of contact for billing inquiries, providing clear and compassionate support to clients. Explain EOBs, balances, and payment options; assist with payment plans as needed. Collaborate cross-functionally with finance, clinicians, and People Ops to resolve billing and credentialing issues. Systems & Reporting Utilize EHR billing systems (Procentive or similar) and payer portals efficiently. Maintain accurate billing records, reporting dashboards, and documentation templates. Use spreadsheets and reporting tools to analyze billing data and support decision-making. Other Duties Handle other billing- and credentialing-related tasks as assigned by the Finance Manager, including participating in special projects and trainings. Requirements Minimum Qualifications High school diploma or equivalent required; Associate's or Bachelor's degree preferred. 5+ years of experience in behavioral health billing and credentialing. At least 2 years of behavioral health credentialing experience. Candidates must be authorized to work in the United States. Sponsorship is not available for this position. Demonstrated experience with: MHCP (Medicaid) billing and requirements Medicare credentialing and enrollment Commercial payer credentialing Strong knowledge of: CPT and ICD-10 coding (behavioral health) Claims lifecycle, denials management, and appeals Experience with EHR billing systems and payer portals (CAQH required). Proven ability to manage and reduce AR aging. Strong attention to detail, organization, and ability to manage multiple priorities. Excellent communication skills with a client-centered, compassionate approach. Preferred Qualifications Experience with Procentive or similar behavioral health EHR systems. Experience with Minnesota-specific behavioral health programs/services. Familiarity with authorization workflows and utilization tracking. Experience preparing for audits or managing compliance reviews. Experience with fee schedule negotiation or payer contract management. Strong reporting and data analysis skills (AR dashboards, KPIs). Experience handling protected health information (PHI) in compliance with HIPAA privacy and security standards. Must maintain a secure and private remote work environment with reliable internet access. Physical Requirements This job operates in a professional office environment and routinely uses standard office equipment. The role requires the ability to remain in a stationary position for extended periods. About Canopy Canopy is a values-based mental health organization committed to centering Black, Indigenous, People of Color (BIPOC) and other historically marginalized and underrepresented communities. We are composed of two sister organizations: (1) Canopy Mental Health & Consulting, and (2) Canopy Roots. The Contract Consultant will work with both organizations. Canopy Mental Health & Consulting (MHC) provides high-quality outpatient psychotherapy and psychiatric services with purpose and integrity. We provide culturally affirming therapy services for historically underserved and marginalized communities in Minnesota. Our services are available in-person in Minneapolis and Richfield and via telehealth statewide. Canopy Roots is an innovative mental health organization offering culturally affirming unarmed first responder services to people in crisis via 911 in the city of Minneapolis. We promote safety for people in crisis by providing emotional de-escalation strategies, crisis intervention support, and connection to appropriate resources. Crisis Responders are members of the communities they serve, reflecting the wide range of cultural and racial identities and experiences of the people who need our services the most. Benefits We care deeply about our employees and know holistic support is essential for our staff to carry out their work. Our generous employment package includes Canopy-sponsored health, dental, and vision insurance options, employer-paid short-term disability insurance, life insurance and AD&D, Flexible Spending Account (FSA), Sick and Paid Time Off accrual,10 Paid Holidays, and 401k retirement plan with employer match. Workplace Culture Canopy Roots and Canopy MHC is a values-based, inclusive workplace that strives to create a space where our 90+ employee's unique talents, learning styles and lived experiences are valued. Creating an engaging work environment is an essential part of our culture. We uphold this commitment through staff surveys and professional development. Our Hiring Process Our human resources team is committed to a person-first centered approach to our hiring process. Candidates can view currently open positions and apply online via canopyrootsmn.com/about/careers. For all positions, our hiring process includes a virtual screening interview and in-person panel interviews, reference checks and background checks for final candidates. All responder candidates must be fingerprinted and reviewed by the BCA and FBI. Persons of color, women, members of the LGBTQ community, veterans, and individuals with disabilities are strongly encouraged to apply. If you require reasonable accommodation in completing this application, interviewing, or otherwise participating in the employee selection process, please direct your inquiries to the Human Resources team at [email protected]. At this time, we are unable to provide company sponsored visas and are only considering candidates who are eligible to work in the United States. The above statements are not intended to encompass all functions and qualifications of the p osition. Rather, they are intended to provide a general framework of the requirements of the p osition. Employees may be required to perform other functions not specifically addressed in this job description. P.S. Please take the necessary steps to allow emails from the Canopy (@canopyrootsmn.com) and Paycor (@paycor.com) domains so that you receive all emails related to your application process. Also, please make sure to check your spam folder as emails from Canopy and/or Paycor can be marked as spam. Full Job Description