Claims Escalation/Denials Appeals Specialist - Northpoint Recovery Holdings, LLC

Job Title: Claims Escalation/Denials Appeals Specialist

Reports To: Billing & Collections Supervisor

Pay Range: $20-23/hour

Schedule: Monday-Friday 7:30-4:30pm OR 8-5pm MST

Job Type: Rotating - In office 1 week & Work from home 1 week

Northpoint Recovery Holdings, LLC, established in 2009, is a growing, behavioral healthcare treatment platform treating adults with substance use disorder and co-occurring conditions under the Northpoint Recovery brand and adolescents with mental healthcare conditions under the Imagine by Northpoint brand. The Company serves patients with commercial health insurance and is an in-network model. Northpoint has grown from two facilities to fifteen today entirely on a de novo basis with plans to expand rapidly in both existing and new markets. Organizational values include humility, heart, inspiration and conviction. Our commitment to excellence means doing good for others and engaging in innovative empirical based treatment. In short, our mission is to help people get their lives back and show them respect and empathy in the process.

POSITION SUMMARY: As a key member of the Revenue Cycle Management team, the Claims Escalation/Denials Appeals Specialist is responsible for the ongoing collection, denial management, and accounts receivable of assigned accounts. This person will manage and collect outstanding balances from insurance companies for services rendered to Northpoint patients and clients. The Claims Escalation/Denials Appeals Specialist involves working closely with patients, insurance companies, and Northpoint providers to ensure that all payments are collected in a timely manner, and payer denials/rejections are worked and followed up on to exhaustion, or payment of services. The ideal candidate will have a solid understanding of the entire billing life cycle of a patient, to include verifications, pre-authorization, utilization review, appeals, claims submission, claims adjudication, and denials. The ideal candidate will have strong knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems required.

ESSENTIAL RESPONSIBILITIES AND DUTIES:

• Perform collections to ensure receipt of medical claims within twenty-eight (28) days
• Make outbound telephone calls to insurance companies, and utilize payer portals for claims resolution
• Coordinate with insurance companies to ensure timely payment for services rendered
• Follow existing billing and collection protocols to ensure accurate and timely reimbursement
• Review accounts receivable accounts to ensure accurate reimbursement and identify payer issues affecting payment delays
• Contact payers to get a clear understanding of denials and changes needed to receive payment
• Prepare appeals, when necessary, when claim denials are payer errors
• Document all correspondence with payers in the billing system
• Collaborate and coordinate with Utilization Review for prior authorization/medical necessity documentation
• Knowledge of CMS and Third-party payer regulations and guidelines
• Thorough understanding of Explanation of Benefits
• Maintain accurate records of patient billing and payment information
• Provide reports to management on outstanding balances and collections activity
• Provide excellent communication and customer service skills
• Utilize a strong understanding of insurance billing and coding requirements
• Maintain active working knowledge of Northpoint billing and reimbursement requirements by payer
• Collaborate with RCM team and other departments to ensure successful execution of assigned duties and priorities
• Maintain confidentiality in accordance with established policies and procedures and standards of care
• Adhere to all Company policies and procedures
• Perform other job-related duties as assigned

QUALIFICATIONS/REQUIREMENTS:

• Minimum of three (3) years of collections/billing reimbursement/claims escalation in a healthcare system
• Experience in a substance use disorder and/or mental health setting a plus; experience with a facility providing multiple levels of care preferred
• Experience working with commercial medical insurance billing, as well as Medicaid, claims submission, and the technical aspects of billing software
• All-in-one practice management, clearing house and billing software required
• Proficient in navigating through payer portals
• Must be proficient in CPT, HCPCS, and ICD-10 Codes, DSMS and ASAM criteria, data entry for various third party billing and payers, and their reimbursement and denial patterns
• Ability to work well in a team environment, with ability to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems required
• KIPU or similar EHR/EMR experience preferred
• Strong organizational skills with the ability to multitask
• Familiarity with major payer guidelines
• Agility in managing multiple priorities concurrently
• Meticulous attention to detail and high level of accuracy is key
• Demonstrated ability to develop both internal and external working relationships
• Proven skills in working independently on several projects concurrently

PREFERRED KNOWLEDGE AND SKILLS:

• Sense of ethics, integrity, and confidentiality about employee and business issues
• Ability to work independently and within a dynamic team environment
• Maintain professional and technical knowledge
• Excellent critical thinking skills and organizational abilities
• Excellent communication skills; ability to communicate clearly and concisely, verbally and in writing
• Quickly and effectively identify and resolve problematic situations
• Comfortable analyzing information and dealing with complexity
• Attention to detail and accuracy
• Able to handle confidential material in a reliable manner
• Ability to interact and communicate with individuals at all levels of organization
• Ability to perform several tasks concurrently with ease and professionalism
• Ability to effectively prioritize workload in a fast-paced environment
• Proficiency with Microsoft Office Suite

CONDITIONS OF EMPLOYMENT:

• Completion of a tuberculin screening during first week of employment
• Completion of a pre-employment drug screening, post-accident and upon reasonable suspicion of use
• Completion of orientation and required paperwork prior to reporting to work
• Demonstrated computer literacy
• Attendance at all mandatory staff development and training
• Completion of background and professional reference checks

This job description is not intended, and should not be construed, to be exhaustive lists of all responsibilities, skills, efforts or working conditions associated with this job. It is meant to be an accurate reflection of the principal job elements essential for making fair pay decisions about jobs.

Employees with potential access to protected health information must comply with all procedures and guidelines governed by HIPAA.

Northpoint is an Equal Opportunity Employer. Northpoint is an at-will employer. Employment may be terminated at any time by employee, or employer with or without notice.