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Utilization Review and Billing Specialist

POSITION DESCRIPTION

Responsible for the billing and utilization review of our PHP, IOP, and Inpatient services. Ensure timely filing and follow-up of claims to commercial, MCO insurance carriers, and other payors.

RESPONSIBILITIES
 

  • Research and obtain necessary pre-certifications/pre-authorizations for said services.

  • Verify insurance eligibility and benefits for said services.

  • Complete financial paperwork and financial agreements, as needed, with families prior to intake.

  • Ensure that all clients receiving assigned services have up to date and accurate demographic and insurance information.

  • Closely collaborate with clinical staff to obtain the necessary information to complete authorizations and reauthorizations. Attend clinical staffing's as necessary to gather necessary information.

  • Track and complete reauthorizations in a timely manner to ensure continuity of medically indicated services.

  • Pursue single case agreements with insurance companies as needed.

  • Audit data and work with various departments to ensure all claims for assigned services are clean.

  • Create batches and submit claims for all assigned services.

  • Review posted payments for pending or denied claims for all assigned services.

  • Check claim status on appropriate payor systems and contact insurance as needed.

  • Investigate and file an appeal for insurance denials or underpaid claims on assigned services.

  • Review and resolve rejected claims.

  • Conduct calls with clients to review A/R and troubleshoot any billing issues.

  • Timely follow-up with clients and insurance companies regarding missing payments or to resolve financial discrepancies.

  • Complete requests from Medical Records for assigned services and other documentation from payors when insurance is Requesting supporting documentation for services.

  • Review appropriate daily/weekly/monthly reports for assigned services.

  • Meet billing metrics for each assigned service.

  • Provide assorted billing reports to management, when requested.

  • Demonstrate a high degree of skill in communication and positive interaction with all Ryther employees, prospective employees, external agencies/companies, and the community at large.

  • All other duties as assigned..

ESSENTIAL JOB REQUIREMENTS
 

  • Required: Bachelor’s degree or 3+ years of Behavioral Health inpatient billing, all aspects of follow-up on denied and rejected claims, and collections in Washington state.

  • Experience with behavioral health authorization and reauthorization processes and required clinical information related to claims.

  • Preferred: Billing certification/degree.

  • Experience/working knowledge in all aspects of Revenue Cycle Management.

  • Knowledge of commercial insurance and government payor guidelines.

  • Working knowledge of insurance benefits and reimbursement.

  • Proficient in medical terminology, HIPAA, and other critical governmental regulations.

  • Exceptional customer service skills as communicating with clients, providers, staff, and various insurance companies will form a large part of the job.

  • Ability to multi-task and meet deadlines.

  • Ability to comprehend various insurance documentation, analyze and reconcile accounts and follow detailed procedures in an organized and efficient manner.

  • Superior problem-solving and follow-up skills.

  • Strong computer skills (Word, Excel, SharePoint, EHR-billing software, such as Credible).

  • Working knowledge of using a clearinghouse for electronic claims submission.

  • Ability to exercise discretion and maintain both client and employee confidentiality in accordance with HIPAA, contract requirements, or other applicable laws and regulations.

  • Ability to use near constant use of keyboard for typing or 10-key entry.

  • Frequent use of telephone, faxing, scanning, and emails.

  • Occasional use of video conferencing, copying.

AGENCY COMMITTMENTS

  • Commitment to the Mission, Vision, and Values of the agency.

  • Accept and positively engage with people with a variety of lifestyles, behaviors, cultural and spiritual practices, and ability statuses.

  • Effectively manage own work while working within a team environment.

  • Adapt and respond effectively to change.

PAY: $52,500 - $67,100

BENEFITS
Full and part-time employees at Ryther enjoy a variety of competitive benefits including: 
 

  • Comprehensive Medical and Dental Coverage (We pay your medical deductible!)

  • Multiple Retirement Plan Options (403b tax deferred)

  • Generous Paid Leave Program (3 weeks paid vacation, 10 accrued sick days, 5 personal days, and paid holidays)

  • Life Insurance Coverage

  • Professional development funds

  • Ryther is a recognized and accredited non-profit (501c3) which qualifies for the federal public student loan forgiveness program

SUPERVISOR: Billing Manager

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