Claims Processing Specialist

1 week ago

Miami, Florida, United States Promises Behavioral Health, LLC Full time
Position Overview

NOTE: Experience within the Behavioral Health Sector is essential. This role is fully remote, with a preference for candidates from the South Florida area.

Role Summary

The primary focus of this position is to manage the billing of institutional and professional claims to various insurance entities. The specialist will perform audits and conduct thorough research to ensure compliance with payer billing standards for the submission of clean claims. This role will also involve overseeing the billing processes for multiple assigned facilities.


Key Responsibilities

  • Timely submission of accurate claims as per the billing schedule established by management.
  • Provide support for billing functions across other facilities as required.
  • Ensure adherence to specific billing guidelines and communicate necessary updates to management.
  • Reconcile charges within the patient accounting system to confirm that all billable charges are captured and submitted promptly.
  • Manage rebill requests and assist with various billing projects as directed.
  • Review and rectify billing discrepancies in Waystar to facilitate claim submission.
  • Assist in the month-end closing process.
  • Maintain knowledge of all managed care organizations (MCO).
  • Take initiative for personal professional development.
  • Contribute to facility-wide performance improvement initiatives.
  • Perform additional duties as assigned.

Qualifications and Requirements

Education:

  • A high school diploma or an equivalent combination of education, experience, and training that equips the individual with the necessary knowledge, skills, and abilities.

Experience:

  • Required experience in the Behavioral Health field.
  • Preferred five (5) years of experience in a Business Office setting, with at least two (2) years in healthcare office management.
  • One (1) year of experience in a billing environment, including familiarity with verification, certification, authorization, managed care, revenue capture, and payer relationship management.

Knowledge, Skills, and Abilities:

  • Proficient understanding of medical terminology and the ability to accurately document payables, receivables, collections, and operational data.
  • Strong oral and written communication skills in English; capability to perform routine numerical calculations for report compilation; and the ability to exercise sound judgment and discretion in all interpersonal interactions.

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