Financial Operations Specialist

Are you interested in improving the quality of life for the people in your community? Do you have a passion for ensuring that those with mental health and substance use disorders receive the services they need? Are you looking for a place to work that is committed to the development of staff and matching people to work they love? A place that values a diverse workforce that strives for excellence while maintaining a healthy work/life balance?

Then come join us!

*SWMBH provides a potential for hybrid, work from home options after initial, in-office training period*

Minimum starting salary: $46,204 (compensation offered is based on candidate experience and qualifications)

Position Description:

Position Title: Financial Operations Specialist

Department: Operations

Reports To: Chief Administrative Officer (CAO)

Southwest Michigan Behavioral Health (SWMBH) is a $200 million governmental entity managing multiple Michigan Department of Community Health benefits management contracts and business lines over an eight-county region in Southwest Michigan.

SWMBH is currently looking for a Financial Operations Specialist. The Financial Operations Specialist is responsible for healthcare claims-processing related tasks. Position has primary responsibility for claims adjudication, claims payment and check processing for all healthcare claims and for assisting providers in troubleshooting claims issues. Under the direction of assigned Senior Leader assists with administrative functions for the Operations team.

DUTIES and RESPONSIBILITIES:

• Performs adjudication of behavioral health claims for behavioral health services within the Managed Care Information System according to established policy
• Ensures claims payments are made in a timely manner.
• Acts as a resource for Providers regarding claims payment issues.
• Maintains working knowledge Michigan Department of Health and Human Services (MDHSS) allowable codes and their requirements.
• Works in collaboration with Provider Network to maintain contract requirements related to behavioral health billing and claims payment.
• Processes claims recoupments as directed by the Compliance Department after provider audits.
• Maintains HIPAA compliance and identifies potential issues surrounding fraud, waste or abuse of Medicaid funds are appropriately reported to Compliance department.
• Provides claims training to providers network as needed.
• Performs other related functions, as assigned.

ESSENTIAL FUNCTIONS:

• Manages all claims processes related to claims adjudication, processing and check payment.

WORKING ENVIRONMENT and PHYSICAL REQUIREMENTS:

• This position primarily works in an office environment with some flexibility for a hybrid schedule allowing work from home days. It requires frequent sitting, standing and walking. May occasionally be required to travel locally and regionally in own vehicle and to attend conferences or other related events.
• Occasionally lift up to 20 lbs.

QUALIFICATIONS:

• Associate degree or extensive related experience required.
• Minimum of 2 years in a medical billing or claims processing role is strongly preferred.
• Experience in a managed care environment is preferred.
• Knowledge of generally accepted accounting principles and spreadsheet software.
• Strong oral and written communication skills, and excellent interpersonal skills; excellent critical thinking and organizational skills.
• High degree of ethical responsibility, confidentiality and integrity is required.
• Ability to manage multiple projects simultaneously and meet required deadlines.
• Ability to collaborate with others within a team environment and effectively work independently.
• Technology literate and working knowledge of Microsoft Office 365 applications including, Word, Excel, Outlook, and PowerPoint.
• Maintains confidentiality and privacy within MDHHS, Federal, and State guidelines.
• Life experiences with diverse racial, ethnic, and cultural backgrounds, including experience with behavioral health issues is preferred.
• Must be supportive of culturally competent recovery-based practices and person-centered planning as a shared decision-making process.
• Must support a trauma informed culture of safety to aid consumers in their recovery process.

Individuals of diverse racial, ethnic, and cultural backgrounds including those with lived experience with behavioral health issues along with bilingual candidates are encouraged to apply.

Please apply through the Southwest Michigan Behavioral Health website at www.swmbh.org by April 1, 2024. Emailed resumes will not be accepted.

Position includes a full benefit package and salary is commensurate with experience.

SNAPSHOT

Job Title: Financial Operations Specialist

Experience: 2 Years

Position Type: Non-Exempt

Industry: Healthcare

Required Travel: Minimal

Manages Others: No

Keywords: billing, claims, accounting, finance, medical biller, coder