- Professional
- Escritório em Toledo
Harbor is seeking a Claims Specialist to join the Toledo team! This position works collaboratively with internal and external customers to obtain, update, submit, and interpret client account information.
Position is full-time, 40 hours per week.
Education/Experience/Other Requirements:
- Associates Degree in Healthcare Administration or related field or 3 years Revenue cycle experience preferred.
- 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.
Essential Job Competencies/Primary Duties:
- 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.
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?
It is fast-paced and challenging, but you will have a lot of fun in the process. 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
- Employee referral bonuses
- Ability to make a difference in your community!
