Full-Time, Weekdays - No nights, weekends or holidays - ever!

General Description:

This position is responsible for all client billing related tasks for: service authorization when applicable, data entry, claim submission and the successful realization of reimbursement

Essential Job Functions

• Communicate with assigned payers to determine: verification of benefits that are applicable to services being rendered, authorization requirements and behavioral health specific claim submission requirements
• Generates and extracts to Excel, unpaid claims information from applicable billing system reports and payer websites and provides relevant follow-up for successful payment
• Utilizes billing system reports to verify the completeness and accuracy of claim related data elements including but not limited to: missing information reports, yesterday’ s SAL reports, proof sheets, authorization status reports, etc
• Reviews and resolves, by appropriate follow through, claims that may be unrendered in the billing system, unsubmitted due to technical issues or claims that need other resolution for submission and successful payment
• Eligibility verification through Mass REVS, the virtual Gateway and individual carriers when applicable
• Follow-up on submitted claims for appeal of denial or address issues preventing payment.
• Maintains all billing related files, records and logs when applicable
• Initiates and tracks managed care authorizations and re-authorizations when required for assigned payers
• Accounts receivable data entry (including SAL entry as either a primary or secondary responsibility, if applicable) and initial data element entry or corrections
• Performs all functions in relation to applicable payer clinician empanelment and/or credentialing for any payers who require reimbursable clinicians and psychiatry staff members to be individually registered as providers for the facility
• Explanation of benefit (EOB) retrieval in the event of special, global, or individual accounts receivable projects
• Review and analyze eHana or similar systems reports that support claims and resolve any issues that will prevent timely and accurate submission and payment.
• Performs all billing follow-through and collection functions at designated required intervals; maintains accurate and timely documentation of denied claims processing, resubmission and/or resolution history.
• Advises billing manager of individual account resolution issues or payer specific claim payment related issues
• Attends payer-specific or general billing related meetings and trainings as required
• Assist, as part of a rotation, with general building reception responsibilities.
• Other related duties as assigned by supervisor

Skills

• Strong mathematical skills
• Computerized accounts receivable skills
• Attention to detail
• Ability to prioritize work and apply judgment in various situations
• Ability to work independently
• Ability to ensure that task completion is in compliance with applicable laws and regulations
• Ability to multi-task and work in a fast paces environment
• Ability to effectively and professionally communicate with all levels of internal staff members, clients and payer representatives

Qualifications

• High School diploma or equivalent, 2 year degree preferred
• 2 years recent and relevant experience in healthcare billing, including claims submission and processing; claims follow-up in an outpatient or similar healthcare setting, required, preferably in behavioral health
• Current working knowledge of health insurance reimbursement, healthcare claims processing and billing procedures required
• Experience with insurance authorizations required
• Ability to utilize various software applications, including word and excel required
• Strong customer service and interpersonal skills

Other Requirements

• Ability to pass a Criminal Offender Record Information check (CORI)
• Ability to pass a Driver’s license check (RMV)

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