Claims Coordinator

Description:

POSITION SUMMARY:

The Claims Coordinator is responsible for assisting in the day-to-day functioning of the WISE Claims Department, completing the weekly claims audit and coordinating the check run process and eligibility file uploads as necessary. This position will represent ABH and its services in a positive and professional manner and adhere to ABH’s best practices, guidelines, policies and procedures as established, promoting ABH as a leader in behavioral healthcare in all interactions and work.

DUTIES AND RESPONSIBILITIES:

  • Interacts with providers and office staff to answer routine inquiries related to the ABH authorization and claims process, as well as the status of their claims. This responsibility includes but is not limited to: an understanding of the claims process and how it relates to the Mental Health Waiver, coordination with DSS and DXC staff; maintaining a comprehensive knowledge of Mental Health Waiver services with regard to benefits, eligibility, network and referral options, and an understanding of Explanation of Benefit forms, Provider Remittances, Communication forms and the reimbursement process;
  • Performs the weekly claims audit by evaluating claims processed on a daily basis with special emphasis on high dollar submissions, and compiles the audit data into a weekly report.
  • Assists in the claims training and development of new and existing staff and providers;
  • Provides assistance to the department for the claims denial review process and for claims investigation for special claims projects;
  • Process claims, if necessary, and understand the guidelines and policies for any type of claim administered by the WISE Claims Department, including claims with other insurance;
  • Maintains knowledge of procedure (CPT) and diagnostic (ICD-10-CM) codes, medical and behavioral health insurance terminology, as well as a basic understanding of the requirements for the completion of CMS-1500 claims forms;
  • Observes policies and procedures related to confidentiality of medical records, release of information and retention of records;
  • Recognizes and reports problems of potential unethical conduct, fraud and/or abuse to QA Supervisor
  • Employs interpersonal expertise to provide good working relationships with members, providers, facilities and other ABH personnel;
  • Maintains confidentiality of all client protected health information and adheres to all HIPAA related policies and procedures;
  • Performs other tasks/responsibilities as required to support the business operations;
  • Demonstrates ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds.
  • Other duties as assigned

EDUCATION AND EXPERIENCE REQUIREMENTS:

  • Associate’s degree/Bachelor’s preferred in business or related field preferred;
  • Three years of demonstrated work experience in claims processing or in the behavioral health customer service field.

KNOWLEDGE/SKILLS/ABILITIES:

  • In-depth knowledge of the WISE online system created by ABH and used by all the WISE staff;
  • Must be flexible in order to respond quickly and positively to shifting demands;
  • Strong attention to detail; ability to work on multiple tasks and meet deadlines;
  • Excellent PC skills with demonstrated experience using Microsoft Office Package (MS Word, Excel and Outlook);
  • Strong written and verbal communication skills required.
  • Excellent communication skills needed, and the ability to continually prioritize needs of staff and providers.

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We are an Equal Opportunity Employer.


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Advanced Behavioral Health, Inc.

213 Court Street
Middletown, CT 06457

Phone: (860) 638-5309
Fax: (860) 638-5302