Behavioral Health Claims Specialist

3 weeks ago

Draper, United States Threshold Billing Solutions Full time
Job DescriptionJob DescriptionThreshold Billing Solutions, is seeking a highly motivated team member to join our claims and verification of benefits team. As a Claim Specialist this position will be instrumental in analyzing and following up on billed behavioral health claims to determine the appropriate course of action to resolve the claims.
The Claims Specialist will be advocating on the behalf of behavioral health facilities in an effort to obtain reimbursement for services billed. The Claims Specialists will be responsible for submitting claims through our online clearinghouse, following up on claim submission, researching and resolving denials, submitting medical records to insurance companies and verifying the eligibility of new patients.
Responsibilities:The Claims Specialist has the following responsibilities and duties:
  • Follow up on Commercial, Medicaid and Government behavioral health claims by phone calls to the insurance companies, websites, if available, or any other resources.
  • Verifies the status of claims that have been billed to insurance companies on a timely basis according to the productivity guidelines for the Claim Status goals.
  • Update claim statuses and keep detailed notes explaining changes or issues with claims.
  • Identifies, documents, and communicates trends in recurring rejections and denials to Supervisor. Recommends process improvements or system edits to eliminate future denials.
  • Compile and submit medical records to insurance companies when required.
  • Verifying the coverage and eligibility of new patients.
  • Follow-up with facilities, insurance companies, and credentialing departments in regards to claims or billing inquiries.
  • Maintains strict confidentiality and abides by all HIPPA rules and regulations.


Requirements:The Claims Specialist should have the following skills, and experience: (Preferred Not Required)
  • Understanding of medical terminology, diagnosis codes, denial codes, ICD 9-10 Codes, and calculating fee schedules.
  • Strong understanding of UB’s, 1500’s and Remittance Advice (RA’s).
  • Has the experience to know the appropriate questions to ask when calling Insurance companies, to get the necessary information to move forward in resolving the claim.
  • Develops a solid understanding of assigned client processes in order to review and analyze claims and account receivable functions.
  • Identifies client issues consistently and communicates this to their Manager in a timely manner for quick resolution.
  • Adhere to all company policies, procedures and guidelines in addition to insurance regulations at the federal and state level.

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