Revenue Cycle Specialist Level 1 (Denials Specialist)

self-starterBehavioral Health Revenue Cycle Management Solutions, LLC

Job Title: Level 1 RC Specialist

Job Location: This is a remote job.

General Description of the Job

The claims specialist position provides comprehensive support for BHRCMS’s professional behavioral health Revenue Cycle operations. Main responsibility will be analyze, trend and work denials. Other responsibilities may include obtaining and verifying authorizations, verify and update eligibility, cash application and direct data entry of claims into payer portals for Behavioral Health Clients. Review and analyze trends, advising BHRCMS’s leadership regarding conclusions and recommendations. Serve as expert resource for covered areas.

Duties and Responsibilities of this Level

Professional Behavioral Health Insurance Denials: The Level 1Revenue Cycle Claims Specialist investigates, resolves and responds to a multitude of professional behavioral health insurance denials which involves research, analysis and problem solving to prevent denials from occurring in the future.

Eligibility and Authorizations: The Level 1Revenue Cycle Specialist will assist in perform Patient eligibility verification and obtaining authorizations from insurance companies and entering the authorization information into the Electronic Health Record systems.

Behavioral Health Claims: The Level 1Revenue Cycle Claims Specialist must investigate and resolve all claims made under the patient’s behavioral health coverage. This requires the ability to review electronic explanation of benefits from the insurance company, post the contractual obligation, the patient liability, and payment received when applicable to the patient’s account.

Perform other related duties incidental to the work described herein.

Supervisory Responsibility: No

Required Qualifications at this Level

Education: High School diploma or GED is required

Experience: Minimum of three years of billing/collection in healthcare preferred.

Previous experience successfully managing complex projects involving multiple stakeholders with a consistent track record of delivering on time, and/or high quality results preferred.

Knowledge, Skills, and Abilities:

• For denials they need to have experience working in different EHR billing systems, clearinghouses, payer portals, calling and talking to insurance companies about claims, and also have strong skills in current billing and coding practices and guidelines with a strong working knowledge of denials and appeals processes.
• Experience with Idaho Medicaid is a plus.
• Experience with Netsmart’s MyEvolv is a plus.
• Experience working with Google Sheets, Excel Spreadsheets, and drafting emails and appeals letters is critical.
• Experience with performing claim adjustments to reprocess claims is essential.
• Must be a strong self-starter and have very good communication skills.
• Must work well in a team environment and under pressure in a fast paced environment.

The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform related tasks other than those specifically presented in this description.

Behavioral Health Revenue Cycle Management Solutions, LLC is an Affirmative Action/Equal Opportunity

Employer committed to providing employment and consulting opportunities without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Behavioral Health Revenue Cycle Management Solutions, LLC is an at will employer.

Job Type: Full-time

Pay: $17.00 - $19.00 per hour

Schedule:

• Monday to Friday

Work setting:

• Remote

Application Question(s):

• How many years of behavioral Health Revenue Cycle experience do you have?
• How many years of experience do you have using Netsmart's My Evol and/ or Idaho Medicaid?

Work Location: Remote