A Lighthouse is needed to help guide the way; to emit a light that helps navigate turbulent times and warn against the possible dangers ahead. Lighthouse Behavioral Wellness Centers is just such a place, guided by its core values of Hope, Dedication and Community.
As a Reimbursement Claims Specialist, you will review provider claim denials for all Medicaid (Oklahoma Health Care Authority) and Department of Mental Health and Substance Abuse Services (ODMHSAS) and will take all steps necessary to correct denials, assess and monitor trends and provide feedback to ensure resolution and establish steps to avoid future denials.
To meet the increasing needs of our communities it is imperative that all team members understand and successfully reach and maintain the expected performance standard levels. In order to achieve total and sustainable success each person must do their part. Lighthouse will do its part in providing any and all necessary tools and training required to help team members be successful.
DEFINITION:
Under immediate to general supervision, provides reimbursement claim management for all OHCA and ODMHSAS claims. This position is supervised by the Chief Financial Officer.
EDUCATION AND EXPERIENCE:
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Bachelor’s degree preferred but not required in a relatable field or relevant work experience and certifications may be considered in lieu of a degree.
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Experience with medical billing/claims, explanation of benefits and denial codes is required.
KNOWLEDGE AND SKILLS:
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Ability to work effectively and courteously with people from various cultures and backgrounds, and to exercise good professional judgment.
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Ability to communicate effectively, orally and written. Able to follow oral and written instructions.
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High attention to detail and the ability to multi-task
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Experience in Excel and Word
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Ability to research and investigate billing and payer policies.
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Able to assess and identify trends and make recommendations regarding the outcome.
JOB DUTIES AND RESPONSIBILITIES:
This position is responsible and held accountable for the following duties:
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Review and resolve denied billing problems to ensure accurate and complete billing.
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Monitors weekly denied billing based on the following: documentation, billing accuracy, medical necessity, coding, modifier and related issues.
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Using data from the weekly monitoring, identifies and rectifies billing and documentation errors.
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Makes recommendation to Supervisors and Compliance regarding documentation processes and training.
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Responsible for checking all submitted Pl benefits requests daily and notifying clinic staff of results.
- Work with clinic staff to ensure guarantors are entered in EHR correctly.
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Review daily and work with billing staff to clear denied billing and post payments/adjustments to consumer accounts.
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Work with current Insurance clerk to maintain active status for all providers by successfully completing initial and subsequent credentialing packages as required by commercial payers and Medicare.
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Work closely with Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to billing and provider credentialing.
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Maintain accurate provider profiles on CAOH and Clearinghouse program.
- In conjunction with Quality Improvement Specialist, educates and provides training on proper billing, follow-up, and documentation practices.
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Will actively manage, maintain, and communicate denial/ appeal activity to the Chief Financial Officer and Site Supervisors and report suspected or emerging trends related to payer denials.
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Maintains documents and records in an orderly manner and files them quickly and accurately.
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Completes all agency documentation of services in a thorough, accurate and timely manner. Regular and predictable attendance is an essential job requirement.
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Employee must be willing and able to perform all job-related travel normally associated with this position.
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Must meet agency standards of productivity and fiscal responsibility.
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Must meet "satisfactory" expectations at any scheduled job performance evaluation, coaching and/or Performance Improvement Plans.
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Assessment and appraisal of quality of work will be evaluated through training, skill, chart review or special purpose.
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Performs other reasonably related duties as assigned by the immediate supervisor or other management as requested.
Must perform the specific job duties as listed above to meet position expectations.
In addition, must possess skill in working cooperatively and effectively with clients, staff, management, and other professional and community groups; in exercising mature judgment in dealing with people; in presenting ideas clearly and accurately; in reading and comprehending the English language; and in communicating effectively, both orally and in writing.
BENEFITS
Lighthouse offers an excellent benefits package to full-time employees. Benefits include: 100% employer-paid premiums for health, dental, life, and vision insurance; generous paid leave including PTO, sick, and agency holidays, employer matching 401K plan, and paid continuing education.
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401(k)
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Dental insurance
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Flexible spending account
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Health insurance
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Paid time off
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Vision insurance
Job Type
Ability to commute/relocate:
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Ardmore, OK: Reliably commute or planning to relocate before starting work (Required)
Work Location