Behavioral Health Billing & Follow-Up Specialist - 139042

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team committed to quality, collaboration, and continuous improvement.

The Patient Biller III - Behavioral Health Billing & Follow-Up Specialist is responsible for complex hospital billing and follow-up activities with a primary focus on Behavioral Health (BH) services, including inpatient psychiatric and outpatient behavioral health claims.

This role performs advanced billing, follow-up, denial resolution, and account reconciliation functions for behavioral health accounts. Responsibilities include resolving payer denials, identifying root causes, coordinating with clinical and authorization teams, and ensuring compliance with payer contracts and regulatory requirements specific to behavioral health services.

The position requires expertise in payer carve-outs, mental health benefit structures, authorization requirements, and medical necessity criteria related to behavioral health services.

KEY RESPONSIBILITIES:

• Perform billing and follow-up for Behavioral Health (IP Psych and OP BH) accounts
• Resolve complex denials including: No authorization / late authorization, Medical necessity denials (psych criteria), Benefit misclassification (medical vs behavioral health)
• Interpret payer contracts and behavioral health carve-out arrangements
• Coordinate with: Clinical RNs (for medical necessity appeals-related to medical services only), Patient Access / Authorization teams, Denials Management (related to BH/Psych), Credit/Refund Team
• Submit and track appeals through payer portals and correspondence workflows
• Identify trends and escalate systemic issues (e.g., auth gaps, payer processing errors)
• Ensure compliance with: State and Federal regulations, Behavioral health billing guidelines
• Process adjustments, refunds, and credit balances as appropriate
• Maintain productivity and quality standards at an expert level

• Three (3) years of recent acute care hospital billing and collection experience.
• Strong knowledge of medical insurance and State/Federal billing regulations.
• Experience with Behavioral Health billing.
• Experience with insurance claim appeals and denial resolution.
• Knowledge of ICD-10, CPT, HCPCS coding principles.
• Knowledge of UB-04 billing and revenue codes.
• Understanding of payer reimbursement methodologies (DRG, per diem, case rate, fee schedule).

• Behavioral Health / Psychiatric billing experience.
• Experience with: Mental health payer carve-outs, Authorization workflows for psychiatric admissions, and/or Medical necessity criteria (MCG, InterQual, or payer-specific).
• Epic Resolute experience.
• Experience with payer portals (Availity, etc.).
• Prior hospital credit balance/refund experience.
• Strong analytical and problem-solving skills in denial resolution.

• Employment is subject to a criminal background check and pre-employment physical.
• Must be able to work various hours and locations based on business needs.

If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.

For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.

a. "Misconduct" means any violation of the policies governing employee conduct at the applicant's previous place of employment, including, but not limited to, violations of policies prohibiting sexual harassment, sexual assault, or other forms of harassment, or discrimination, as defined by the employer. For reference, below are UC's policies addressing some forms of misconduct:

• UC Sexual Violence and Sexual Harassment Policy
• UC Anti-Discrimination Policy
• Abusive Conduct in the Workplace