Billing & Claims Specialist

Job Description

Job Description

Salary: $30$45 per hour (DOE)

Billing & Claims Specialist

About Prosperous Health

Prosperous Health is dedicated to providing compassionate, evidence-based behavioral health and substance use disorder treatment services. Our mission is to support individuals in achieving lasting recovery, improved mental health, and long-term wellness through high-quality, client-centered care.

We foster a collaborative, clinically driven environment where excellence in care, ethical practice, and continuous improvement guide everything we do. Our multidisciplinary team is committed to delivering meaningful outcomes for the individuals, families, and communities we serve.

Join a Growing Behavioral Healthcare Platform

Prosperous Health is a rapidly growing behavioral healthcare platform dedicated to delivering exceptional mental health, substance use disorder, and integrated medical services across multiple levels of care.

Our organization is built around a comprehensive continuum of care that supports patients throughout every stage of treatment, recovery, and long-term wellness. Through inpatient treatment, outpatient services, telehealth, psychiatric care, and innovative medical programs, Prosperous Health provides coordinated, patient-centered care across California.

Prosperous Health Network

Our behavioral health network currently includes:

• Prosperous Health Lake Hughes 104-bed inpatient behavioral health & substance use disorder treatment campus
• Prosperous Health San Juan Capistrano Outpatient behavioral health program
• Prosperous Health Rancho Palos Verdes Outpatient behavioral health program
• Prosperous Health Woodland Hills Outpatient behavioral health program
• Prosperous Health Virtual Care Statewide telehealth behavioral health program

Position Summary

The Billing & Claims Specialist is responsible for managing the billing and claims process for behavioral health services, ensuring timely claim submission, payment posting, denial management, and reimbursement optimization. This role works closely with clinical staff, insurance providers, and the revenue cycle team to maintain accurate billing practices and support the financial health of the organization.

Pay Range: $30$45 per hour (DOE)

Essential Duties and Responsibilities

• Prepare, review, and submit insurance claims accurately and timely
• Verify insurance eligibility, benefits, and authorization requirements
• Monitor claims through the reimbursement process and follow up on outstanding claims
• Investigate and resolve claim denials, rejections, and payment discrepancies
• Post insurance and patient payments accurately
• Work with commercial insurance plans, managed care organizations, and government payers
• Maintain accurate patient billing records and documentation
• Collaborate with clinical and administrative staff to ensure complete and compliant documentation
• Respond to billing inquiries from insurance companies and internal departments
• Reconcile accounts and assist with accounts receivable follow-up
• Maintain compliance with HIPAA regulations and payer guidelines
• Identify opportunities to improve billing efficiency and revenue cycle performance
• Perform other revenue cycle and billing duties as assigned

Qualifications

• Minimum of 2 years of medical billing and claims experience required
• Experience in behavioral health, mental health, or substance use disorder billing preferred
• Knowledge of commercial insurance, Medi-Cal, Medicare, and managed care billing processes preferred
• Experience with electronic health records (EHR) and medical billing software
• Familiarity with CPT, ICD-10, and HCPCS coding standards
• Strong understanding of insurance verification, claims processing, and denial management
• Excellent organizational, analytical, and problem-solving skills
• Strong attention to detail and accuracy
• Ability to prioritize tasks and meet deadlines in a fast-paced environment
• Excellent written and verbal communication skills
• Proficiency in Microsoft Office Suite, including Excel

Benefits

Prosperous Health offers a comprehensive benefits package designed to support employee well-being and professional growth, including:

• Medical, Dental, and Vision Insurance
• Paid Time Off (PTO)
• Paid Sick Leave
• Paid Holidays
• Professional Development Opportunities
• Supportive and Collaborative Work Environment

Why Join Prosperous Health?

At Prosperous Health, our team is committed to making a meaningful difference in the lives of those we serve. We value compassion, integrity, teamwork, and operational excellence. If you are passionate about supporting behavioral healthcare through accurate billing, claims management, and exceptional revenue cycle practices, we encourage you to apply.

Join our team and help transform lives through compassionate, client-centered care.

Equal Opportunity Employer

Prosperous Health is an Equal Opportunity Employer committed to fostering a diverse, inclusive, and respectful workplace. We welcome applicants from all backgrounds and experiences and are dedicated to promoting equity, belonging, and professional growth.