Behavioral Health Claims Specialist

3 weeks ago

Prescott, United States Medusind Full time
At Medusind we take immense pride in offering superior, cost-effective solutions covering the whole spectrum of tasks and processes to the healthcare industry. A significant factor is that our workforce comes with rich domain expertise and robust compliance norms.

Our four-prong approach of an excellent management team coupled with a detailed eye for processes experienced manpower, and cutting-edge technology helps us deliver superior, cost-effective services to our clients across the globe.
Position Details: Fulltime, fully remote, $21.50 Hourly.
 
Primary Job Responsibilities:
  • Research and document denials in a thorough, professional, and expedient manner.
  • Analyze denied claim explanations of benefits, insurance carrier contacts, and general correspondence from insurance companies.
  • Request medical records from internal staff when needed.
  • Compose all correspondence in accordance with regulatory requirements, to reflect accurate appeal information in a clear, concise, grammatically correct format.
  • Maintain tracking system of correspondence and outcomes for appeals.
  • Maintain well-organized, accurate, and complete files for all appeals.
  • Monitor each appeal to ensure all internal and regulatory timelines are met.
  • Act as point of contact for submission and/or resolution of denial determinations and interfaces with insurance companies in regard to reconsiderations, disputes, and/or appeals.
  • Responsible for data collection and analysis regarding specific denial determinations and appeals.
  • Develop necessary policies and procedures and oversee quality assurance measures related to appeals.
  • Review denied claims looking for large trend issues.

Skill Requirements:
  • Must have experience appealing denied insurance claims for out-of-network providers (preferably in behavioral health).
  • Computer literacy and proficiency in programs such as Microsoft Excel and Word. 
  • Understanding of state and regulatory grievance and confidentiality regulations.
  • Ability to handle confidential material with discretion and integrity.
  • Excellent verbal and written communication skills.
  • Ability to establish and maintain positive and effective work relationships with coworkers and clients.
  • Ability to work independently as well as in a team environment.


About Medusind:

Since 2002, organizations across the entire healthcare spectrum have leveraged our deep expertise and high-quality solutions to maximize revenue, reduce operating costs and navigate the changing healthcare landscape.Medusind’s unique combination of deep industry expertise, robust operational capability, and client-focused service significantly improves the efficiency and profitability of healthcare organizations. Client satisfaction is the primary focus of the Medusind leadership and staff.Our highly experienced personnel, cutting edge technology, and forward thinking approach allows us to deliver effective solutions while staying ahead of healthcare industry changes.

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