Job Description

POSITION SUMMARY: Under supervision of the Client Services Manager, performs work in support of those providing services to an adult population composed of persons with substance-use disorders, SMI, dual-diagnoses and/or referred persons. Responsible for ensuring timely and accurate billing and reimbursement from various health plans; coordinating and overseeing the claims process and supervising claim staff; and performs related duties as required.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

The duties listed below are intended only as illustrations of the types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to this classification.

 

  • Trains, supervises, evaluates and mentors claims staff.
  • Works with internal departments and external vendors to enhance billing accuracies.
  • Audits billing entries to ensure compliance and accuracy.
  • Maintains EDI enrollments for ERA/ clearinghouse.
  • Audits clearinghouse transactions for accuracy.
  • Oversees the process of various reports to the Regional Behavioral Health Authority in accordance with contract requirements, including client demographics.
  • Coordinates and oversees the claims process, including but not limited to submission of initial claims based on payer specific requirements, follow-up and research of denied claims, insurance verification and verification of client eligibility and processing remittance, both manual and electronic.
  • Develops procedures and forms as necessary to enhance and expedite the billing and claims processes.
  • Maintains records and prepares reports.
  • Provides regular reporting to management.
  • Assists in any and all audits relating to the Finance Department.

EDUCATION/LICENSE/CERTIFICATION/EXPERIENCE REQUIREMENTS:

  • A High School diploma/GED and a minimum of three years of related claims processing or insurance billing experience; a minimum of one year of supervisory experience
  • Experience with coding guidelines, preferred
  • Must be 21 years of age
  • Background Check
  • Minimum typing speed of 35 wpm