Claims Specialist

Soultenders, Inc. is a forward-thinking company dedicated to revolutionizing the accessibility of quality mental health services by offering comprehensive administrative support to licensed professionals.

We are seeking a detail-oriented and proactive Claims Specialist to join our dynamic team. This role presents an exciting opportunity for someone passionate about mental health and skilled in resolving complex billing challenges.

Job Summary:

The successful candidate will be responsible for managing insurance claims, re-billing corrected claims, verifying patient eligibility, maintaining accurate data, documenting resolution activity, and collaborating with clinicians and external payers.

Key Responsibilities:

• Claims Management: Monitor and manage outstanding insurance claims, ensuring prompt resolution according to industry regulations and carrier guidelines.
• Re-billing: Follow up on re-billed and corrected claims to ensure timely submission within carrier filing deadlines.
• Patient Eligibility Verification: Accurately obtain and verify patient eligibility, coverage, benefits, and authorization information from carriers.
• Data Management: Maintain updated patient, payer, and claim-related information, addressing discrepancies that could affect reimbursement.
• Documentation: Record all outstanding claim resolution activity within TherapyNotes, ensuring accurate and timely documentation.
• Collaboration: Communicate with clinicians, external payers, and relevant entities to resolve outstanding claims, working closely with management to stay informed about new processes and best practices.
• Patient Communication: Respond to inquiries via phone and email regarding claims and billing concerns.
• Compliance & Reporting: Report clinician non-compliance issues related to claims resolution and assist in resolving problem claims as directed.

Requirements:

• Education: High school diploma or equivalent required.
• Experience: Minimum 1-2 years of experience in healthcare claims processing, insurance billing, or a related administrative role, preferably in mental health or behavioral health settings.
• Technology Skills: Proficient in Microsoft Office Suite (Word, Excel, Outlook) and familiar with billing software and EHR systems.
• Compliance: Knowledge of federal and California state healthcare regulations, including HIPAA and insurance carrier requirements.

Benefits:

Full-time employees are eligible for a comprehensive benefits package after a 90-day probationary period, including medical, dental, and vision insurance, 401(k) Retirement, and competitive compensation.

Soultenders, Inc. is committed to creating an inclusive work environment, supporting the well-being of our employees through competitive compensation and benefits, while fostering a mission-driven organization making a meaningful difference in mental health care.

We are an equal opportunity employer, committed to a diverse and inclusive workforce, ensuring non-discrimination in hiring and employment practices, complying with federal, state, and local laws regarding employment practices.