Denials Specialist RCM - Level 1

The claims representative position provides comprehensive support for BHRCMS’s professional behavioral health revenue cycle operations.This position is critical in ensuring the accuracy, efficiency, and integrity of our billing and collections process.

Duties and Responsibilities may include:

• Communicate and operate effectively as a member of a team in a remote setting.
• Eligibility and Authorizations: The Level 1 Revenue Cycle Claims Specialist will assist in performing client eligibility verification and obtaining authorizations from insurance companies and entering the authorization information into the Electronic Health Record systems.
• Behavioral Health Claims Processing: Process claims adjustments, denials, rebills, drop to secondary/patient responsibility, etc. as assigned.
• The representative should have an understanding of Remittance Advice Remark Codes and the steps to take to resolve.
• The representative should have the skills to re-work claims, write multi level appeals and speak directly with the payers as needed.
• Cash application and direct data entry of claims into payer portals for Behavioral Health Clients, the majority of which are located in Massachusetts.
• Analyzing, trending, and working denials.
• Follow established procedures and meet daily productivity goals.
• Work independently while collaborating with remote teams when needed.
• Telephone insurance carrier/patient to seek resolution on accounts.
• Do claim corrections and/or work with manager on multi-levell claim appeals- submit to the payer for processing.
• Identify trends in assigned claim work and inform management if not able to resolve with payer.
• Comment on every claim worked following established standard operating procedures (SOP’s) .
• Maintain necessary logs/spreadsheets.
• Participate on camera in departmental meetings as necessary.
• Help with specific projects assigned.
• Employees may be directed to perform related tasks other than those specifically presented in this description.
• Meet with supervisor at scheduled intervals

• Massachusetts Behavioral Health billing knowledge preferred
• CareLogic,eHana, Availity, and/or myEvolv EHR proficient preferred
• Denial management experience required
• Eligibility experience preferred
• Authorization experience preferred
• Microsoft Office - Proficient - (Excel, Word) required
• Excellent communication skills (verbal and written) are essential
• Detail-oriented, systematic, and innovative
• Strong analytical and problem-solving skills
• Must be able to meet deadlines, work independently, set priorities, and maintain confidentiality
• Ability to work calmly and efficiently in high-pressure situations

Required Qualifications at this Level

Education: High School diploma or GED is required, College Degree preferred Experience: At least 1-2 years of billing/collection in healthcare is required.

1+ years (Behavioral Health/Psych Preferred)

Previous experience successfully managing complex projects involving multiple stakeholders with a consistent track record of delivering on time and/or high-quality results preferred., * How many years of behavioral health billing experience do you have?, * Revenue cycle management: 2 years (Required)

• Claims : 2 years (Required)

Health insurance, Paid time off, Vision insurance, Dental insurance, Life insurance Contract, Full-time Remote, Behavioral Health Revenue Cycle Management Solutions, LLC is an Affirmative Action/Equal Opportunity

BHRCMS is committed to providing employment and consulting opportunities without regard to an individual’s age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Behavioral Health Revenue Cycle Management Solutions, LLC is an at-will employer.

Job Type: Full-time

Supervisory Responsibility: No

Salary: The pay range listed is an estimate. Pay is determined by multiple factors, including, but not limited to, a candidate’s geographical location, relevant education, experience, skills, and an evaluation of internal pay equity.

Remote Work Requirements - Must have reliable high speed internet. Minimum standard speed for optimal performance of 10 x 1 (10mbs download x 1mbs upload) required. Must have a separate private workspace / desk area designated for home office to ensure absolute and continuous privacy while at work.

Job Types: Full-time, Contract

Pay: $17.00 - $19.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance