Drug Rehabilitation Billing Specialist

Position Overview The Drug Rehabilitation Billing Specialist owns end-to-end revenue cycle operations for the substance use disorder portfolio, expanding as the portfolio grows. The role focuses on commercial out-of-network (OON) billing across detox, residential, partial hospitalization (PHP), and intensive outpatient (IOP) levels of care. Core Responsibilities —  Submit claims end-to-end for detox, residential, PHP, and IOP levels of care across commercial OON payers —  Monitor claim status, work pending and rejected claims through the clearinghouse, and ensure timely resolution —  Conduct denial management, including root cause analysis and corrective resubmission —  Draft and submit appeals for OON denials and underpayments, coordinating with Utilization Review for clinical documentation —  Post ERAs and patient payments, reconcile against expected reimbursement, and surface underpayments for follow-up —  Coordinate with Utilization Review Directors and Patient Collections Managers at portfolio facilities

Required Experience

—  Two to five years of hands-on substance use disorder billing experience —  Demonstrated experience with OON commercial billing, including OON benefits, billed charges, balance billing, and OON reimbursement dynamics —  Working understanding of single case agreements and their billing implications —  End-to-end revenue cycle competency including submission, follow-up, denial management, appeals, and payment posting —  Proficiency with UB-04 facility claims and CMS-1500 professional claims, including bill types, revenue codes, HCPCS codes, modifiers, and place-of-service codes for substance use disorder levels of care —  Working knowledge of major commercial payers and their behavioral health carve-outs (e.g., Optum BH, Magellan, Evernorth, Carelon)

Preferred Qualifications

—  Hands-on experience with EHRs, practice management systems, and clearinghouses (Sunwave / Waystar a bonus) —  Inpatient substance use disorder billing experience —  Experience billing for facilities operating in Florida or other heavily regulated substance use disorder markets —  Familiarity with Title 42 CFR Part 2 confidentiality requirements —  Prior experience at a back-office billing organization or in-house billing team at a multi-facility substance use disorder operator —  HIPAA workforce member experience and familiarity with PHI handling requirements