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Position Title: Claims Analyst – Behavioral Health
FLSA Status: Hourly
Type of Position: Full Time
Department Name: Client Management 
Reports To: Revenue Cycle Manager

JOB SUMMARY
The Claims Analyst – Behavioral Health is responsible for the submission of clean and timely patient claims to commercial, Medicare and Medicaid insurance companies.

ESSENTIAL FUNCTIONS OF THE JOB

  • Review assigned reports and correct claims that are on hold or rejected. Note accounts as appropriate.
  • Review system reports to identify delinquent accounts.
  • Perform insurance verification to determine coverage and benefit eligibility of patient.
  • Follow up with insurance to identify reason for non-payment. Take the appropriate and necessary action to have the claim paid.
  • Respond promptly to inquiries, concerns and problems related to billing.
  • Maintain a positive dialogue and collaborative working environment.
  • Maintain thorough and detailed knowledge of medical fee schedules and reimbursement rules for numerous states including but not limited to Florida, Kentucky, Missouri, andNorth Carolina.
  • Exhibit an understanding of federal, state and contractual guidelines/regulations as it relates to Medicare, Medicaid, Managed Care, and Commercial Insurance companies to ensure ongoing compliance.
  • Demonstrate thorough knowledge of UB and 1500 electronic and hardcopy billing forms, formats, and filling requirements.

OTHER DUTIES AND RESPONSIBILITIES OF THE JOB

  • Exhibit an understanding of CPT, HCPCS, Revenue Codes, ICD-10 diagnosis and procedure coding guidelines.
  • Knowledge of HIPAA rules and regulations.
  • All other duties as assigned.

SKILLS AND ABILITIES

  • Preferred knowledge of medical terminology, CPT/HCPCS/UB04 revenue coding, modifiers, and billing regulations, documentation standards, fee schedules, third party billing and documentation standards.
  • Preferred knowledge of Behavioral Health codes and experience in claim analysis for Behavioral Health facilities.
  • An overall knowledge of functions & activities of medical offices/hospitals, understanding of compliance, knowledge of various payment systems, skill in researching and resolving problems and issues
  • Strong computer skills with knowledge of Microsoft Outlook, Word, Excel and practice management systems.
  • Excellent interpersonal skills and experience interacting with personnel (clinical staff and finance/management/administration).
  • Excellent written and oral communication skills.
  • Strong team player.
  • Adherence to strict confidentiality.
  • Able to plan, analyze and prioritize workload.
  • Meet deadlines and function independently.

EXPERIENCE REQUIREMENTS

  • Three (3) to Seven (7) years’ experience in medical claims submission, follow-up, and correction for multiple payors and claim types for a Federally Qualified Health Center, preferably in Florida, Kentucky, and North Carolina.
  • Experience across multiple practice management systems, clearinghouses, and payers strongly preferred.

EDUCATION / CERTIFICATION REQUIREMENTS

  • High School Diploma or GED equivalent required.
  • Coding Certification a plus.

PHYSICAL REQUIREMENTS ESSENTIAL TO PERFORM THE DUTIES OF THE JOB

  • Frequently remains in a sitting position at a desk to perform duties.
  • Frequently communicates with co-workers, customers, and contractors/vendors in person, on the telephone, and on the computer.
  • Frequently works in a well-lit room.
  • Frequently views the computer to perform duties.
  • Frequently uses the computer with fingers and hands for documentation and communication.
  • Occasionally stoops, bends, or kneels.
  • Occasionally exposed to outside elements when traveling for business.
  • Occasionally required to push and/or pull objects.
  • Occasionally lifts and/or carries objects weighing up to twenty (20) pounds.

COMPENSATION

  • Competitive salary and incentive bonus commensurate with experience along with Fortune 500 level benefits.

To apply send your resume to careers@altruis.com.