Claims Specialist

Company: Easterseals Blake Foundation
Location: Tucson
Posted on: June 25, 2022

Job Description:

Easterseals Blake Foundation is committed to the safety and well-being of our employees, our members, and the communities we serve. As such, we require all employees to be fully vaccinated from the COVID-19 virus. Proof of full vaccination status is required prior to the start of employment. Medical or religious waivers may be requested.The Billing and Claims Specialist is responsible for submitting claims to multiple payers, posting payments, working the denials and following up with appeals when necessary. The Billing and Claims Specialist will run and analyze reports pertaining to claims and accounts receivables to ensure that all charges are submitted and collected within the time frames defined in the contracts with the funding sources.Essential Duties & Functions (with or without accommodation):

• Gathers and submits the initial claims to assigned payers, either electronic directly to the funder, through the clearing house or on paper claim forms
• Downloads and processes the response files from the payers.
• Reviews the EOBs and processes the rejections and denials in a timely manner, as prescribed by the funding contracts.
• Posts payments in the electronical health record system.
• Manages the appeals and follow-up with the different carriers.
• Conducts claims analysis to address patterns of underpayments and/or denials.
• Responsible for finding solutions, working assigned claims, identifying and documenting problematic issues that prevent the successful and timely submission of accurate claims.
• Manages and/or obtains authorizations for payment.
• Has a good understanding of benefits and eligibility rules for each payer.
• Maintains up to date knowledge of coding: CPT, HCPCs and ICD-10.
• Communicates efficiently with the Eligibility, Data Validation, Electronic Health Records and Clinical departments to attain the common goal of processing clean claims and maintain a low account receivable balance.
• Provides reports on billing and claims to leadership.Knowledge and Skills (with or without accommodation):
  • Minimum two years' experience in behavioral health billing and claims processing
  • Appropriate knowledge of behavioral health system, including AHCCCS, Medicaid, Medicare and private insurances.
  • Knowledge of HIPPA and patient privacy rules.
  • Ability to work independently and seek supervision appropriately.
  • Must be well organized, able to multi-task, detail oriented, accurate, and able to complete projects and assignments in a timely manner
  • Excellent verbal and written communication skills
  • Flexibility and ability to respond to changing priorities
  • Computer proficient (experienced with Microsoft Office Suite, Electronic Health Records and Clearing House programs)
  • Capable of managing stress in a fast-paced, unpredictable, and high intensity setting
  • Must be reliable, punctual and flexible.
  • Ability to maintaining highly confidential information.
  • Displays cultural sensitivity and demonstrates the ability to form constructive and collaborative working relationships with others from diverse cultural backgrounds.
  • Ability to communicate in a culturally inclusive manner and being open to other people's differences.Minimum Qualifications:Education:
    • High School diploma or GED andExperience:
      • Minimum two years' experience in behavioral health billing and claims processing.
      • Commercial billing experience preferred.
      • Demonstrated ability to work with people.
      • Pleasant disposition with professional presentation both in person and on the phone.
      • Must have ability to work as a team member and be tactful when demands are made.
      • Demonstrated excellent organizational skills.Regulatory:
        • Must be able to meet training and agency compliance requirements for the position.
        • Proof of COVID-19 vaccination required.
        • Must be at least 21 years of age
        • Must possess a current AZ Fingerprint Clearance Card or have the ability to obtain one.
        • Valid Arizona driver's license and the willingness to use personal vehicle in the course of employment.
        • Must meet minimum requirements of agency insurance carrierEasterseals Blake Foundation is an EEO/AA/Vet/Disabled Employer

Keywords: Easterseals Blake Foundation, Tucson , Claims Specialist, Other , Tucson, Arizona