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Caring Connections for Special Needs, LLC

OverviewThis position is located in Benson Arizona. CCSN will be considering Arizona based candidates at this time.Caring Connections for Special Needs (CCSN) improves the behavioral health and wellness of children through a family support approach. We are founded on the belief that we must focus on our children and families and follow our CORE FOCUS to improve the lives of children and families. What makes our services unique is the fact that we offer our enrolled members tools and techniques to benefit the daily life of both the children and families we serve.CCSN is adaptable to child/family needs and looks to provide family support services such as parenting education, assistance in finding employment, and time management to meet the essential needs of the family. We strive to build trust and develop positive relationships with our members and families.Responsibilities of the PositionThe Behavioral Health Claims Billing and Denial Specialist reports directly to the Billing Manager and is responsible for investigating, correcting, and resolving denied claims related to outpatient mental health, community-based behavioral health services, case management, and rehabilitative services. While the primary focus of this role is managing denials to ensure accurate reimbursement and compliance with Medicaid, managed care organizations (MCOs), Medicare, and commercial insurance payer requirements, the specialist is expected to perform any duties within the billing department assigned by the Billing Manager. This position works closely with clinical, authorization, and billing teams to reduce denial trends, improve revenue cycle performance, and support the overall needs of the billing department as directed.Responsibilities of the Claims and Denial Specialist include but are not limited to the following:Denial Review and Resolution&middot; Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) for denied or underpaid behavioral health claims.&middot; Identify root causes of denials including authorization issues, medical necessity determinations, documentation deficiencies, credentialing discrepancies, timely filing limits, and incorrect modifiers.&middot; Correct and resubmit claims as appropriate.&middot; Prepare and submit formal appeals within payer timeframes.Appeals&middot; Draft appeal letters addressing medical necessity denials using clinical documentation.&middot; Collaborate with licensed clinicians to obtain treatment plans, assessments, and progress notes.&middot; Ensure documentation supports billed CPT and HCPCS codes.&middot; Track appeal deadlines and outcomes.Authorization and Eligibility Coordination&middot; When required, verify prior authorizations for therapy, intensive outpatient services, community-based services, and skills training.&middot; Ensure units are billed aligned with authorized units.&middot; Identify patterns related to authorization lapses or eligibility errors.Revenue Cycle Improvement&middot; Maintain denial tracking logs by payer, provider, service type, and CPT/HCPCS code.&middot; Provide monthly denial trend analysis to leadership.&middot; Recommend corrective action plans to reduce recurring denial categories.Compliance and Regulatory Standards&middot; Ensure compliance with HIPAA, Medicaid regulations, and payer-specific billing policies.&middot; Maintain confidentiality of protected health information (PHI).Required Qualifications&middot; Must be 21+ years of age or older, in accordance with Dept. of Health Services R9-20-204.&middot; High School Diploma or GED required; Associate&rsquo;s degree preferred.&middot; Computer proficiency (MS Office- Word, Excel, and Outlook)&middot; Proficiency in Microsoft Excel for reporting and tracking.&middot; Minimum 2 years of behavioral health billing or claims denial experience.&middot; Strong knowledge of CPT, HCPCS, and ICD-10 behavioral health coding.&middot; Experience with EHR and behavioral health billing platforms.&middot; Strong written communication skills for appeal drafting.&middot; Must maintain a current/valid/unrestricted AZ DPS Level 1 Fingerprint Card&middot; TB test within 7 days of hire.&middot; Must be able to meet and maintain training and agency compliance training requirements for the position.&middot; Ability and willingness to receive coaching and feedback.Preferred Qualifications&middot; Experience with Medicaid Managed Care Organizations (MCOs).&middot; Certified Professional Biller (CPB) preferred.&middot; Experience with community-based behavioral health billing.Key Competencies for Success for a Claims Denial Specialist&middot; Analytical and detail oriented.&middot; Strong understanding of behavioral health documentation standards.&middot; Ability to interpret clinical notes for medical necessity.&middot; Organized and deadline driven.&middot; Effective cross-department communication.Performance Expectations&middot; Maintain denial rate below organizational target.&middot; Resolve assigned denials within established turnaround times.&middot; Ensure 100% compliance with appeal deadlines.Pay: $22.00 - $25.00 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Health savings account</li><li>Paid time off</li><li>Vision insurance</li></ul>Experience:<ul><li>Claims , Billing and Denial: 3 years (Required)</li><li>Behavioral Health claims: 2 years (Preferred)</li></ul>Work Location: In person

Claims Billing and Denial Specialist

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Caring Connections for Special Needs, LLC

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Claims Billing and Denial Specialist