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Form of workJob Description
An understanding of the time frame in which a claim needs to be paid out from a health insurance company requirements. Candidate will be working closely with the Invoice financing department and help them determine which invoice/claims are worth buying off treatment facility before distributing finances. Invoice factoring knowledge is a plus but not required.
Responsibilities:
-Audit treatment facilities claims and verify which claims are payable within 30-60 days. Report to Invoice Financing department with potential invoices/claims that could be bought off from facility.
-Create a invoice/claims spreadsheet that were purchased and allocate all payments as they are being paid by health insurance.
-Consult on payable and unpayable claims to Invoice financing department.
-Monitors accuracy and timeliness of financial collections with health insurance companies and reports to Invoice financing department.
-Review Aging reports and follow up on payments and update Invoice financing department on payment information.
-Review purchased invoice that have been denied for payment and for the underpaid claims.
-Be able to verify and determine which claims will be paid before the contract is signed by potential facility and Invoice financing department.
-Oversees all areas of reimbursement operations to ensure timely and accurate for treatment facilities invoices are paid out by health insurance company.
-Follow-up with insurance carrier on unpaid claims within standard billing cycle time from Health insurance companies.
-Call insurance companies regarding any discrepancy in payments. (Determine any write offs and duplicate charges)
-Monitor all postings to ensure that all checks or payments are received in real time and applied correctly to our system.
-Provide spreadsheets of treatment facilities outlying status on all outstanding invoices/claims that were purchased.
Qualifications:
- Active California State Clinical license
- Minimum of 5 years of experience in Utilization review in the behavior health industry.
- Demonstrated understanding and experience in the billing industry.
- Working knowledge of local, state, and federal regulations.
- Excellent verbal and written communication skills.
- Previous experience with Joint Commission, CARF, and regulatory standards compliance is desired.
- Need to know the level of appeals.
Job Type: Contractor or Full- time employment
Salary: $70,000 - $80,000 a year (Depending on experience)
Work location: In person
Hours: Minimal 25-30 hours a week
Location: 315 S. Beverly Drive, Suite 212, Beverly Hills, CA 90212
