AR Denial Specialist

Job Description

Job Description

Hybrid Position - 2 days in office

Pay Range: $24.00 - $27.00 Hourly plus Bonus Structure

Behavioral Health Group (BHG) is the largest network of Joint Commission-accredited treatment centers and a leading provider of opioid addiction treatment services. With over 116 locations in 24 states and a team of more than 1,900 employees, we are dedicated to helping individuals overcome substance use disorders and reclaim their lives. Join us in making a difference.

Job Summary

This position will act as a key member of the Revenue Cycle Department  and reports to the Director, Contract and Revenue Cycle. The Revenue Cycle Specialist will help facilitate claims, payments, and verifications daily. The Revenue Cycle Specialist will provide updates and reports on the financial stability of the treatment centers.

Summary of Essential Job Functions

The key responsibilities of the Revenue Cycle Specialist include but not limited to:

Duties and Responsibilities

• Reviews claims data to ensure 3rd party billing requirements are met
• Reviews claims to ensure eligibility, prior authorizations and proper signatures
• Submits claims in an organized sequence in order to achieve reimbursement from private payers, insurance companies and government healthcare programs Medicaid, VA, etc.)
• Investigates denied claims through research and applicable correspondence and follows through to resolution
• Successfully resolves payment discrepancies in a timely manner
• Escalates issues appropriately and promptly to supervision
• Verifies and informs treatment center staff about the patient’s financial accountability and 3rd party reimbursement, as applicable
• Posts payments and adjustments while ensuring all deposits are balanced daily
• Documents payment records and issues as they occur
• Completes reporting requirements as required by company policy and requested by supervision
• Demonstrates an understanding of NPI, taxonomy and electronic claim submission requirements
• Identifies underpayments and overpayments/credits to determine steps for resolution
• Retrieves missing payment information from payers through various methods (phone, payer portals, clearing houses, etc.)
• Reads debits and credits on accounts and takes necessary action to resolve
• Performs other duties assigned by supervision

Regulatory

• Responsible for complying with all federal, state and local regulatory agency requirements
• Responsible for complying with all accrediting agencies
• Marketing and Outreach
• Participate in community and public relations activities as assigned.
• Professional Development
• Responsible for the achievement of assigned specific annual goals and objectives
• Demonstrates the belief that addiction is a brain disease, not a moral failing
• Demonstrates hope, respect, and caring in all interactions with patients and fellow Team Members
• Establishes and maintains positive relationships in the workplace
• Can work independently and under pressure while handling multiple tasks simultaneously
• Makes decisions and uses good judgment with confidential and sensitive issues
• Deals appropriately with others in stressful or other undesirable situations

Training

• Participate in and provide in-service trainings as required by federal, state, local, and accrediting agencies
• Attend conferences, meetings and training programs as directed
• Participate in and/or schedule and attend regular in-service trainings

Other

• Demonstrated commitment to valuing diversity and contributing to an inclusive working and learning environment

Minimum Requirements

The Revenue Cycle Specialist will be responsible for reviewing claims data to ensure insurance requirements, eligibility, prior authorizations and proper signatures are secured prior to submission. Submits claims in an organized sequence in order to achieve reimbursement from private payers, insurance companies and government healthcare programs with heavy concentration in Medicaid.  Will investigate declined claims through research and applicable correspondence in order to successfully resolve payment discrepancies.

Qualifications

The Revenue Cycle Specialist must have the following qualifications.

• High school Diploma or equivalent

In addition to meeting the qualifications, the ideal candidate will embody the following characteristics and possess the knowledge, skills and abilities listed below:

• Denial Management Skillset
• Strong knowledge of Excel
• High integrity
• Excellent verbal and written communication skills
• Sound judgment
• Efficient
• Self-starter
• Strong interpersonal communication skills
• Valid driver’s license.
• Healthcare experience preferred.
• Experience in front desk, admissions, billing, and/or collections.
• Excellent verbal and written communication skills.
• Strong customer service and interpersonal communication skills.
• Accurate data entry and basic keyboarding skills.
• Ability to work independently under pressure and handle multiple tasks simultaneously.
• Ability to enforce fee collection policies.
• Basic computer/word processing skills.
• Knowledge and use of typical office equipment (calculator, fax machine, copier, computer, telephone, postage meter, scales, scanner, and computer programs).
• Knowledge of basic math, accounting, and accounts receivable.

Physical Requirements and Working Conditions

The physical demands described here are representative of the requirements that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions to the extent such accommodation does not create an undue hardship on the business.

• Communicate effectively by phone or in person.
• Vision adequate to read correspondence and computer screens.
• Prolonged sitting, some bending, stooping, and stretching.
• Manual dexterity for operating office equipment.
• Variable workload and periodic high stress.
• Standard medical office environment.
• Interaction with patients with various health and legal issues.
• Extended keyboarding periods.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by team members assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of team members so classified. All team members may be required to perform duties outside of their normal responsibilities from time to time, as needed, and this job description may be updated at any time.

BHG is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law.

Why Join BHG?

Work-Life Balance: Enjoy generous paid time off, holidays, and personal needs. Benefit from flexible schedules with early in/early out hours, no nights, and no Sundays.

Investment in Your Growth: Prioritize your development with role-based training and advancement opportunities.

Comprehensive Benefits: Choose from three benefits programs, including health, life, vision, and dental insurance. Enjoy tuition reimbursement and competitive 401K match.

Recognition and Rewards: Experience competitive pay, quarterly bonuses, and incentives for certifications or licenses.

Employee Perks: Access exclusive discounts on various services and entertainment options, and benefit from our Employee Assistance Program and self-care series.

At BHG, we thrive on the greatness of our people. Join us and become part of a community that values excellence, integrity, and making a real difference in the lives of others.

BHG is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law.

Starting Pay Range: $23-$25/hr