Utilization Review And Intensive Services Billing Specialist

Are you looking to put your organizational and billing skills to work for a company you can be proud to represent? Ryther is a recognized leader in behavioral health services for children and their families facing complex challenges. We are seeking an Utilization Review and Intensive ServicesBilling Specialist to join our team of dedicated and motivated professionals. Successful candidates will have excellent organizational skills, attention to detail, and the highest quality of professionalism and reliability.

As the Utilization Review and Intensive ServicesBilling Specialist you will be responsible for the billing and Utilization Review of our PHP, IOP, and Inpatient services. You'll ensure timely filing and follow-up of claims to commercial, MCO insurance carriers, and other payors. . You'll help ensure timely payments from insurance carriers and other payors, as well as provide regular financial reports to management.

If you like problem solving, work well on a team, and have previous behavioral health billing experience, we'd love to hear from you. Billing certification/degree is preferred but not required; suitable experience may be substituted. Must have 3+ years of behavioral health billing experience for Washington State.

RESPONSIBILITIES

• Research and obtain necessary pre-certifications/pre-authorizations for said services.
• Verify insurance eligibility and benefits for said services.
• Complete financial paperwork and financial agreements, as needed, with families prior to intake.
• Ensure that all clients receiving assigned services have up to date and accurate demographic and insurance information.
• Closely collaborate with clinical staff to obtain the necessary information to complete authorizations and reauthorizations. Attend clinical staffing's as necessary to gather necessary information.
• Track and complete reauthorizations in a timely manner to ensure continuity of medically indicated services.
• Pursue single case agreements with insurance companies as needed.
• Audit data and work with various departments to ensure all claims for assigned services are clean.
• Create batches and submit claims for all assigned services.
• Review posted payments for pending or denied claims for all assigned services.
• Check claim status on appropriate payor systems and contact insurance as needed.
• Investigate and file an appeal for insurance denials or underpaid claims on assigned services.
• Review and resolve rejected claims.
• Conduct calls with clients to review A/R and troubleshoot any billing issues.
• Timely follow-up with clients and insurance companies regarding missing payments or to resolve financial discrepancies.
• Complete requests from Medical Records for assigned services and other documentation from payors when insurance is Requesting supporting documentation for services.
• Review appropriate daily/weekly/monthly reports for assigned services.
• Meet billing metrics for each assigned service.
• Provide assorted billing reports to management, when requested.
• Demonstrate a high degree of skill in communication and positive interaction with all Ryther employees, prospective employees, external agencies/companies, and the community at large.
• All other duties as assigned..

ESSENTIAL JOB REQUIREMENTS

• Required: Bachelor's degree or 3+ years of Behavioral Health inpatient billing, all aspects of follow-up on denied and rejected claims, and collections in Washington state.
  
• Experience with behavioral health authorization and reauthorization processes and required clinical information related to claims.
• Preferred: Billing certification/degree.
• Experience/working knowledge in all aspects of Revenue Cycle Management.
• Knowledge of commercial insurance and government payor guidelines.
• Working knowledge of insurance benefits and reimbursement.
• Proficient in medical terminology, HIPAA, and other critical governmental regulations.
• Exceptional customer service skills as communicating with clients, providers, staff, and various insurance companies will form a large part of the job.
• Ability to multi-task and meet deadlines.
• Ability to comprehend various insurance documentation, analyze and reconcile accounts and follow detailed procedures in an organized and efficient manner.
• Superior problem-solving and follow-up skills.
• Strong computer skills (Word, Excel, SharePoint, EHR-billing software, such as Credible).
• Working knowledge of using a clearinghouse for electronic claims submission.
• Ability to exercise discretion and maintain both client and employee confidentiality in accordance with HIPAA, contract requirements, or other applicable laws and regulations.
• Ability to use near constant use of keyboard for typing or 10-key entry.
• Frequent use of telephone, faxing, scanning, and emails.
• Occasional use of video conferencing, copying.

AGENCY COMMITTMENTS

• Commitment to the Mission, Vision, and Values of the agency.
• Accept and positively engage with people with a variety of lifestyles, behaviors, cultural and spiritual practices, and ability statuses.
• Effectively manage own work while working within a team environment.
• Adapt and respond effectively to change.

Ryther seeks to create a work environment that reflects the diverse community that it serves. People of color, LGBTQIA, persons with disabilities, and multi-lingual individuals encouraged to apply. Our diversity is our strength!

This is a Full Time position, Monday - Friday, with a comprehensive benefit/leave package, and opportunity to work remotely, with occasional in-office attendance.

BENEFITS
Full and part-time employees at Ryther enjoy a variety of competitive benefits including:

• Comprehensive Medical and Dental Coverage (We pay your medical deductible!)
• Multiple Retirement Plan Options (403b tax deferred)
• Generous Paid Leave Program (3 weeks paid vacation, 10 accrued sick days, 5 personal days, and paid holidays)
• Life Insurance Coverage
• Professional development funds
• Ryther is a recognized and accredited non-profit (501c3) which qualifies for the federal public student loan forgiveness program

SUPERVISOR: Billing Manager