Description

Path Behavioral Healthcare is looking to add an experienced Billing Specialist/Credentialing Specialist with at least 2-3 years of Billing experience to the team as a full-time member. Under the direction of the Director of Revenue Cycle Management, the Billing Specialist/Denial Management Specialist is responsible for monitoring denials, appeals, and resolutions from participating insurance carriers and working proactively to collect from insurance carriers. Must possess experience with Medicaid for the STATE of UTAH and Out of Network Commercial insurance denial management. Willingness to learn multi-states is crucial. Work from home position, must have computer and high-speed internet. Will meet twice a week, at a minimum, for video meetings.

Job Responsibilities and Duties

• Accurately processes insurance payments and electronic remittance files and reconciles to patient accounts within 1 day from deposit date.

• Accurately codes charges using generally accepted coding rules for ICD-10 and CPT

• Reviews denials and initiates corrective action on a daily basis.

• Processes electronic and paper claims and submits to payer or clearinghouse with necessary attachments and documentation to support the claim.

• Maintains account receivables by following up on outstanding claims.

• Researches all information needed to complete the billing process to include getting charge information from providers as needed.

• Maintains documentation and reporting for all activities as reported by policy and law.

• Completes processes and reporting related to month end.

• Works to take immediate action and resolution of issues.

• Researches and analyzes denial data and coordinate denial recovery responsibilities.

• Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials

• Develop reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement.

• Prioritizes activities to work overturns in a timely manner to alleviate untimely filings

• Uses reports that categorize denials to assign tasks or personally work to overturn denials

• Identifies and pursues opportunities for improvements in denial performance

• Assists with chart audits as necessary

• Processes work lists to facilitate prompt intervention of insurance denials

• Researches, responds, and documents insurer and patient correspondence/inquiry notes regarding coding coverage, benefits, and reimbursement on patient accounts

• Research rejections included in EOBs for resolution and files appropriately

• Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks

• Runs daily report from the EMR and compare to ensure all insurance changes have been entered on both sides.

• Working with PRISM to accurately enroll employees into Medicaid.

• Keeping track of all employees’ credentials through a roster

• Making sure all employees licenses/certifications are active

Qualifications

• Minimum 2-3 years’ experience in a Billing Specialist/Credentialing Specialist role, preferably in Mental Health and/or Behavioral Health specific to the State of UTAH.

• Experience with UTAH Medicaid and Commercial insurance denial management.

• Should possess proficient to expert skills in Microsoft Word, Microsoft Outlook, OneDrive products, and Internet research.