Insurance Services Supervisor

2 weeks ago

Bakersfield California, United States Embark Behavioral Health Full time
Overview:

Insurance Services Supervisor

Pay: $30.00 - $35.00

The Insurance Services Supervisor will oversee an Insurance Services team to effectively implement and complete the billing and collections processes for Embark BH programs. The primary responsibilities for this role include building a cohesively effective billing and collections team to ensure that they are successfully managing the timely and accurate submission of claims to respective payors.   The role will include duties such as working closely with the various organizational department heads. Duties will also include ensuring each Insurance Services Rep of the Embark BH programs are regularly meeting or exceeding all federal and state regulations, and in accordance with the Embark BH Policy and Procedures.

The Insurance Services Supervisors will oversee the provider enrollment/credentialing process for Embark Behavioral Health.  This individual is responsible for working with insurance companies to ensure timely completion of provider enrollment for each facility and their therapists for non-contracted payors and credentialing of therapists for contracted payors.  The individual will work closely with the programs and therapists to document and validate their license and credentials. 

The Insurance Services Supervisor will be required to provide oversight in maintaining billing and collections standards, overseeing the insurance billing, answering correspondence promptly, and preparing and disseminating pertinent reports as needed.  This role requires a person skilled in maintaining healthy relationships, developing effective teams, and can maintain productive communication skills with a variety of professionals.

The main responsibilities for this role include oversight of claims submission, denial management and responsibilities associated with insurance billing.  The Insurance Services Supervisor will be required to interface with the Revenue Director, operational managers, operational staff, insurance companies, utilization review teams, and families.                                                                                                                                                                                                                                                                                                                                                                                                                                                

Responsibilities:
Provide oversight to the Insurance Services team and actively participate in workloads to remain a subject matter expert in all things related to the department.

Serve as primary point of contact for all things related to provider enrollment and credentialing. Delegate work between team members to ensure a smooth and efficient enrollment and credentialing process.

Maintains a roadmap for provider enrollment requirements for each payor and state where Embark has programs.

Maintain practitioner electronic data files for Embark Behavioral Health clients; utilizing CAQH to submit practitioner data as required to credential individual practitioners for contracted payors

Ensure workload assignments are managed and balanced effectively.

Ensure Insurance Services Reps complete timely and accurate verification of benefits for insurance coverage as related to Behavioral Health coverage.

Ensure Insurance Services Reps complete timely and accurate processing of invoices and claims; responsible for submitting clean electronic and paper claims to insurance companies.

Responsible for oversight of rejected claims from clearinghouse and/or insurance companies. Includes tracking of trends, documenting best practices to mitigate rejections, and ensure low acceptable rejection rate.

Responsible for oversight of timely responses to insurance denials, monitoring for trends, and providing feedback on operational processes.

Ensure timely responses on requests for refunds as received from insurance company; requests will be validated for accuracy and challenged when not accurate.

Ensure process and procedures are followed to allow for timely invoicing of patient co-pays and deductibles, private pay collections and A/R management.

Monitor Specialist assigned accounts to ensure identification of overdue payments and refunds are issued for overpayments.

Review and approve Specialist recommendations on adjustments, refunds, and outside collection activity in alignment with company policy and procedures.

Partner with the Utilization Review team to ensure timely billing to third party payors.

Host and participate in regular billing coordination meetings and provide feedback for problem solving with insurance billing and A/R issues.

Support the Revenue Director in cash application process, making sure all cash receipts are applied accurately and timely.

Oversee staff to include hiring recommendations, coaching/mentoring, and salary recommendations.

Qualifications:
A minimum of 3-5 years prior work experience in medical billing and accounts receivable, preferable in a medical or behavioral-healthcare environment.

Proven managerial skills with 2-3 years in a supervisor/lead role.

History of effective and proven leadership skills combined within a team environment.

Experience with electronic claims filing.

Prior experience with credentialing a plus.

Working knowledge of Windows-based applications, including Outlook, Word and Excel partnered with hands-on experience with accounting software.

Strong interpersonal organizational, evaluative and time management skills.

Knowledge of state and federal regulations governing insurance billing and reimbursement.

Ability to work effectively with a wide range of constituencies.

Excellent written and verbal communication skills as evidenced by the ability to prepare, present, and review oral and written information and detailed reports

Working knowledge of Windows-based applications, including Outlook, Word and Excel.

Patience and ability to manage stress and maintain confidentiality.

Associate degree and/or related experience.

Embark Behavioral Health is a unique organization comprised of extraordinary programs dedicated to bringing the current all-time high rates of adolescent anxiety, depression, and suicide to all-time lows within the decade while becoming the most recognizable, respected, and valuable behavioral health organization in the world.  

Embark is a leading network of clinical and therapeutic programs (residential treatment centers, young adult transition programs, outpatient centers, addiction treatment facilities, wilderness therapy programs, support services, and more) that offer a comprehensive set of services that run the span of acuities, ages, and services.  All programs offer state-of-the-art therapeutic interventions, lead the way in quality standards, deliver measurable outcomes and are all tied together via a shared set of core values (empathy, service, trust, growth, and results).

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