Archived listing. The details below describe a past opening.
Harbor is seeking a Claims Specialist to join the Toledo team! This position preforms timely, effective and efficient revenue cycle tasks to ensure accurate claim submission and receipt of payment. Works collaboratively with internal and external customers to obtain, update, submit, and interpret client account information.
Position is full-time, 40 hours per week.
REQUIREMENTS
Education:
- Associates Degree in Healthcare Administration or related field or 3 years Revenue cycle experience preferred.
Experience:
- Demonstrated knowledge and understanding of health/behavioral health billing procedures and eligibilities for third-party providers preferred.
- Knowledge of governmental and commercial insurance rules and regulations.
- Must have strong attention to detail.
- Previous coding experience in a behavioral healthcare setting preferred.
- Excellent communication and interpersonal skills.
- Must be able to establish daily work priorities and work independently and efficiently to meet deadlines.
- Must be honest, dependable, self-disciplined, organized and be able to work well as a team member.
RESPONSIBILITIES
Essential Functions and Primary Responsibilities:
- Works collaboratively with the team to identify and complete projects with Revenue Cycle team.
- Receives incoming questions from clients, payers and/or clinicians regarding client accounts; initiates data submission for any additional information needed, and interprets information back to the client, payer and/or clinician.
- Verifies insurance coverage, co-payment, and coordination of benefits and updates client billing information accordingly.
- Reviews, monitors, updates and ensures timely submission and follow up for payer authorizations.
- Initiates denials process, including appeals and status requests.
- Identifies and tracks denial trends, using both the organizations EHR system and clearinghouse to create robust denial prevention processes.
- Participates, leads and initiates conversations with payers about matters with complex claims and reimbursement policies.
- Uses denial tracking as a tool to recognize opportunity within the department and facilitates additional staff training, and/or new workflow ideas to reduce overall denial rate.
- Provides coverage for claim submission and clearinghouse rejections when needed.
- Maintains current knowledge regarding public payers, third-party and first-party payment procedures and regulations.
- Monitors dashboard and runs reports daily to monitor and initiate corrective actions as necessary to ensure accuracy and completeness of billing, service and charge information for timely submission.
- Reviews charges for accuracy and follows up timely on claim generation errors.
- Keeps current with trends and developments related to essential job competencies and demonstrates continued growth.
General Competencies/Performance Expectations:
- Utilizes information technology systems and software applications effectively and in accordance with organizational standards and security protocols.
- Demonstrates sound judgment by analyzing information thoroughly, reaching timely conclusions, and taking appropriate, decisive action.
- Plans, prioritizes, and organizes work to ensure maximum efficiency, productivity, and quality outcomes.
- Actively seeks and utilizes supervision and feedback appropriately to support professional growth and effective job performance.
- Manages time and utilizes leave in accordance with organizational policies and procedures.
- Performs additional duties and responsibilities as assigned to support departmental and organizational needs.
Working Conditions:
- Office-based position.
- Travel expectations: driving an agency vehicle and transporting clients or driving their own vehicle for work.
- Exposure to confidential information.
- Potential exposure to behavioral, crisis and environmental situations.
- This position is non-union.
About Harbor:
- A leading provider of mental health and substance use treatment for over 100 years.
- 350+ clinical staff serve over 24,000 clients across multiple locations and in the community each year.
- Services ranging from counseling, pharmacological management, primary care, psychological testing, case management, substance use treatment, residential services, vocational program, and more!
Why Work for Harbor?
You will have the opportunity to meet other motivated individuals who are also making a positive impact at our company. Harbor is committed to investing our resources in you! Some benefits of working with Harbor include:
- Medical, dental, and vision coverage
- Retirement plan with company match
- Generous paid time off, sick time, and paid holidays
- Tuition and professional license reimbursement programs
- Clinical supervision hours offered
- Ability to make a difference in your community!