Reimbursement Specialist

Responsible for ensuring optimal and timely reimbursement by maintaining accurate client eligibility information and resolving errors before claims are filed. Work closely with clinicians to improve processes, efficiencies, and productivity.

POSITION SPECIFIC DUTIES & RESPONSIBILITIES:

• Generate and complete assigned reports, adhering to established schedules and completion timelines, utilizing the electronic health record system, Report Manager, and PICIS.
• Ensure accuracy of data submitted to guarantors and state agencies, by reviewing, verifying, and updating client information in electronic health record system, including demographics, financial eligibility, services, diagnoses, and authorizations.
• Communicate and collaborate with other agency staff and outside entities, in order to correct errors, resolve issues, and provide assistance to staff both within the department and throughout the agency.
• Execute all assigned tasks, following departmental processes and procedures, and meeting all goals as set forth by the department.
• Review all clinicians daily billing reports to ensure accuracy.
• Make recommendations for updates, changes or process improvements in order to capture available billing in timely manner for program.

QUALIFICATIONS

EDUCATION:

• Must be a high school graduate or have HS equivalent

EXPERIENCE:

• Minimum of two years’ experience with Medicaid and ODMHSAS eligibility verification, billing, and authorizations within an outpatient behavioral health setting.
• Experience with Medicare and other third party billings is a plus.

PERFORMANCE COMPETENCIES:

• Generate and Deliver Reports
• Process and Procedures
• Essential Behaviors
• Billing compliance and Accurancy

KNOWLEDGE/SKILLS/ABILITIES:

• Requires a strong understanding of current Medicaid and ODMHSAS rules and regulations in regards to behavioral health, along with knowledge and understanding of HIPAA laws and client privacy.
• Proficient in communication, internal and external customer service, and time management.
• Strong organizational skills and attention to detail is a must.
• Ability to function independently and to maintain an effective working relationship with agency employees.
• Must be efficient, timely, and accurate in all duties and responsibilities.
• Must conduct self professionally, maintain confidentiality, and have strong computer skills, including proficiency in Excel.

SAFETY SENSITIVE JOB CLASSIFICATION:

This job is classified as a “safety-sensitive” position as defined by the Oklahoma Medical Marijuana and Patient Protection Act. Due to the “safety-sensitive” classification, an employee in this position would be subject to drug and alcohol testing, including random testing. Marijuana is one of the substances included in the drug panel screening. Possession of a medical marijuana license will not excuse you from the testing process or the consequences of testing positive for marijuana per the Family & Children’s Services Drug Free Workplace Policy, including possible revocation of a job offer or dismissal from employment.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.