Claims and Reimbursement Specialist

Job Title: C'aims and Reimbursement Specialist

Report To: Chief Financial Officer/Chief Programs Officer

Position Summary: The Claims and Reimbursement Specialist is responsible for managing insurance claims, reimbursement processes, and payment resolution for mental and behavioral health services. This role ensures accurate billing, timely claim submission and effective follow up with payers to support the financial health of the organization while maintaining compliance with healthcare regulations.

Key Responsibilities:

· Submit, track and manage insurance claims for mental and behavioral health services

· Assure staff is credentialed

· Review claims for accuracy, completeness and compliance with payer requirements

· Follow up on denied, rejected or underpaid claims and initiate appeals as needed

· Promptly enter ADAMHS registration data into the GOSH system

· Verify authorization requirements and coverage limitations on insurance benefits

· Post payments, adjustments and denials accurately in the billing system

· Apply all patient payments

· Routinely work in liason with billing provider in resolving and providing required information for billing claims and billing provider

· Maintain detailed records of claim activity and reimbursement outcomes

· Assist CFO to secure payments due and reduce accounts receivable

-Other administrative financial/billing duties as needed or assigned

Qualifications:

-High School diploma or equivalent required; Associates or Bachelor's degree preferred

-1-3 years of experience in medical billing, claims processing or reimbursemet

-Experiencej in mental health or behavioral health billing preferred

Requirement of Position: Proven experience as billing specialist preferred or experience and education in a classroom setting specific to current billing and claims. Knowledge of electronic health record’s systems and adherence to laws and best practices in regards to dealing with customers and protected health information.

The intent of this job description is to provide a representative summary of the major duties and responsibilities to be performed in this position. This position is subject to change and the employee in this position might be requested to perform job related tasks other than those presented here.

Job Types: Full-time, Part-time

Pay: $17,600.00 - $33,000.00 per year

Work Location: In person