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Claims Specialist

4 months ago

Portland, United States Fora Health Full time
Job DescriptionJob Description
The mission of Fora Health is to provide treatment, care and advocacy for all who are affected by substance use disorder.  We are committed to providing a wide range of accessible, coordinated and well‑integrated services that benefit the community and support our patients to recover and to maintain recovery from addiction.  To maintain an organizational culture which supports the mission, each employee will, at a minimum:
  1. Understand substance use disorders and their treatment, including understanding of medications to treat substance use disorders, harm reduction, and trauma informed care.
  2. Recognize the importance of family, social networks, and community systems in the treatment and recovery process.
  3. Respect the diversity and uniqueness of each person and organization we serve.
  4. Recognize that a healthy work environment is maintained through the practice of mutual respect and healthy self-care.
  5. Uphold the highest standard of customer service to patients, referents, and all community partners.

The Claims Specialist assures that this mission is the foundation for the delivery of services and carrying out job duties.

POSITION SUMMARY
We are seeking a meticulous and detail-oriented Claims Specialist to join our dynamic team. This role is vital in ensuring the accuracy and timeliness of processing of health insurance claims. You will be responsible for reviewing, analyzing, and processing medical claims in accordance with our company policies and regulatory guidelines. The ideal candidate will have a strong commitment to learning the behavioral health billing model including claims requirements, payor regulations, provider models and more.
This role will report directly to the Contracts and Billing Supervisor.

ESSENTIAL JOB FUNCTIONS
  • Review and verify claims for completeness and accuracy.
  • Enter claim data into the system, ensuring accurate processing and record-keeping.
  • Communicate with health care providers and policyholders to gather additional information or clarification needed to process claims.
  • Analyze and interpret medical records and insurance policies to make appropriate decisions regarding claim approvals or denials.
  • Resolve claim discrepancies and prepare adjustment requests as needed.
  • Resolve claim rejections as needed.
  • Provide backup support to denials team as needed.
  • Meet individual and team performance targets related to productivity and accuracy.
  • Stay updated on changes in health care regulations and insurance policies that may affect claims processing.
  • Provide excellent customer service by assisting policyholders and providers with inquiries about claims status and payments.
  • Complete billing audits as required
  • Participate in ad-hoc projects related to billings, collections or denials.
  • Participate in billing and/or intake related meetings as necessary and offer advice/perspective as it relates to billings and authorizations.

SUPERVISORY FUNCTIONS
This position has no supervisory responsibilities.

QUALIFICATIONS
EDUCATION AND EXPERIENCE REQUIRED
  • High school diploma or equivalent; associate degree in a related field preferred.
  • Excellent data entry skills with a high level of accuracy and attention to detail.
  • Excellent problem-solving skills and the ability to manage time effectively.
  • Excellent written and verbal communication skills.
  • Proficient in Microsoft Office applications, especially Excel
  • Ability to maintain confidentiality of sensitive information and documents
  • Ability to collaborate, organize and meet tight deadlines.
  • Strong customer service skills and experience

KNOWLEDGE, SKILLS AND ABILITIES PREFERRED
  • Advanced knowledge of coding, modifier usage and denial reason codes
  • Experience in web-based insurance portals and billing clearinghouses
  • Experience in electronic health systems
  • Proven ability to prioritize responsibilities to ensure that they are completed in a timely manner

OTHER REQUIREMENTS
  • DHS Background Check Approval
  • Successful completion of Drug Test upon hire
  • Documentation of Tuberculin test and/or evaluation with negative results or evidence of non-communicability
  • At least two years of continuous sobriety


HOURS AND PAY
This is a full time, non-exempt position. The hourly pay rate will be between $21.16-22.89 (depending upon experience).

Location
This position will either be remote or hybrid and will be determined at time of hire.

ABOUT FORA HEALTH

Looking for a meaningful career? At Fora Health, we employ a team of passionate, diverse and caring people who are committed to carrying out our mission to provide treatment, care and advocacy for all who are affected by substance use disorder. We are seeking dedicated individuals to join our experienced team of professionals in the fight to overcome the stigma of addiction and mental health. Come join one of Oregon’s largest and most reputable providers of substance use disorder and co-occurring mental health treatment for adults

Fora Health is committed to providing a wide range of accessible, coordinated, and well-integrated services that benefit the community and support our clients to recover and to maintain recovery from addiction. To maintain an organizational culture which supports Fora's mission, each employee will, at a minimum:

  1. Have knowledge of substance use disorders.
  2. Recognize the importance of family, social networks, and community systems in the treatment and recovery process.
  3. Respect the diversity and uniqueness of all people.
  4. Recognize that a healthy work environment is maintained through the practice of mutual respect and healthy self-care.
  5. Uphold the highest standard of customer service to clients, referents, and all community partners.

BENEFITS

  • Regence BlueCross BlueShield medical insurance
  • Comprehensive dental and vision insurance
  • Employer-paid basic life and accidental death & dismemberment insurance
  • Additional voluntary insurance (short-term disability insurance, supplemental group life insurance, accident & critical illness insurance, and pet insurance)
  • Flexible Spending Account (FSA) for healthcare, dependent care and transportation costs
  • 401K plan with Employer Matching up to 6%
  • 4 weeks paid vacation, one floating holiday & sick leave
  • 10 observed holidays, paid bereavement and paid jury duty days
  • Flexible schedules
  • Employee Assistance Program
  • Discounted 24 Hour Fitness membership from $6.99/month
  • One free employee meal on days worked at our Cherry Blossom location
  • Online education tools for CEUs
  • Critical shift compensation up to double hourly pay rate and shift premiums for certain positions
  • Employee referral bonus
  • Education grant program reimbursement for continuing education expenses after 90 days of employment
  • Loan forgiveness for eligible medical and clinic positions
  • Free parking at our two facilities

Employees may be eligible for education grants:

  • National Health Service Corps (NHSC)
  • NURSE Corps
  • Public Service Loan Forgiveness (PSLF)

Fora Health is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Fora Health encourages applications from those who are in recovery. Please note that we require individuals in recovery to certify that they have at least two years of continuous sobriety upon hire.

Fora Health is a second chance employer and complies with applicable laws regarding consideration of criminal background for employment purposes. Fora Health conducts a background check for all positions upon offer of employment. Government regulations, contractual requirements, or the duties of certain jobs may require us to take appropriate action to address prior criminal convictions.

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