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Description

POSITION SUMMARY:

The Claims Coordinator is responsible for assisting in the day-to-day program functioning and completing the weekly claims audit and coordinating the check run process and eligibility file uploads as necessary. This position will represent ABH® and its services in a positive and professional manner and adhere to ABH®’s best practices, guidelines, policies and procedures as established, promoting ABH® as a leader in behavioral healthcare in all interactions and work.

DUTIES AND RESPONSIBILITIES:

• Performs weekly claims processing for the BHRP-Clinical and the Military Support Program.
• Performs regular claims processing and adjustments for the BHRP-Basic Program.
• Performs as needed claims processing and adjustments for the Pre-Trial Intervention Program.
• Performs the weekly claims audit by evaluating claims processed on a daily basis with special emphasis on high dollar submissions and compiles the audit data into a weekly report;
• Performs all other check runs and the eligibility file process as needed;
• Assists in the claims training and development of new and existing staff;
• Assists in running regular financial reporting on a weekly and monthly basis.
• Provides assistance to the department for the claim’s denial review process and for claims investigation for special claims projects;
• Provides assistance to program staff as it relates to claims payment questions;
• Maintains knowledge of procedure (CPT) and diagnostic (ICD-9-CM) codes, medical and behavioral health insurance terminology as well as a basic understanding of the requirements for the completion of both the HCFA and the UB-92 claims forms;
• Interacts with providers and office staff to answer their routine inquiries related to the ABH® process as well as the status of their claims. This responsibility includes but is not limited to: understanding of the claims process and maintaining a comprehensive knowledge of program policies and services with regard to benefits, eligibility, network and referral options and an understanding of Explanation of Benefit forms, Provider Remittances, Communication forms and the reimbursement process;
• Observes policies and procedures related to confidentiality of medical records, release of information and retention of records;
• Recognizes and reports problems of potential unethical conduct, fraud and/or abuse to the Vice President;
• Employs interpersonal expertise to provide good working relationships with members, providers, facilities and other ABH personnel;
• Maintains confidentiality of all client protected health information and adheres to all HIPAA related policies and procedures;
• Demonstrates ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds;
• Performs other tasks/responsibilities as required to support the business operations.

Requirements

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Associate’s degree/Bachelor’s preferred in business or related field preferred;
• Three years of demonstrated work experience in claims processing or in the behavioral health customer service field;
• Attends trainings specific to job duties;
• Attends annual Conflict of Interest.

KNOWLEDGE/SKILLS/ABILITIES:

• In-depth knowledge of ABH’s various utilization management and claims systems created by ABH and used by all the GA staff;
• Must be flexible in order to respond quickly and positively to shifting demands;
• Strong attention to detail; ability to work on multiple tasks and meet deadlines;
• Excellent PC skills with demonstrated experience using Microsoft Office Package (MS Word, Excel,  Outlook);
• Strong written and verbal communication skills required.