Partners Behavioral Health Management

Compensation

Full Description

Competitive Compensation & Benefits Package!   Position eligible for –  * Annual incentive bonus plan * Medical, dental, and vision insurance with low deductible/low cost health plan * Generous vacation and sick time accrual * 12 paid holidays * State Retirement (pension plan) * 401(k) Plan with employer match * Company paid life and disability insurance * Wellness Programs * Public Service Loan Forgiveness Qualifying Employer See attachment for additional details.    Office Location:  Remote Option; Available for any of Partners' NC locations Projected Hiring Range:  Depending on Experience Closing Date:   Open Until Filled Primary Purpose of Position: This position is responsible for ensuring that providers receive timely and accurate payment.    Role and Responsibilities:   50%: Claims Adjudication  * Responsible for finalizing claims processed for payment and maintaining claims adjudication workflow, reconciliation and quality control measures to meet or exceed prompt payment guidelines.  * Responsible for reconciling provider claims payments through quality control measures, generally accepted accounting principles and agency’s policies and procedures.  * Assess Title XIX and non-Title XIX claims adjustments for correction or recoupment and will coordinate the recoupment process to ensure payment is recovered for inappropriately paid claims. * Provide back up for other Claims Analysts as needed. 40%: Customer Service   * Maintain provider satisfaction by being available during regular business hours to handle provider inquiries; interacting in a professional manner; providing information and assistance; and answering incoming calls. * Assist providers in resolving problem claims and system training issues.  * Serve as a resource for internal staff to resolve eligibility issues, authorization, overpayments, recoupments or other provider issues related to claims payment. 10%: Compliance and Quality Assurance  * Review internal bulletins, forms, appropriate manuals and make applicable revisions * Review fee schedules to ensure compliance with established procedures and processes.  * Attend and participate in workshops and training sessions to improve/enhance technical competence.    Knowledge, Skills and Abilities:  * Working knowledge of the Medicaid Waiver requirements, HCPCS, revenue codes, ICD-10, CMS 1500/UB04 coding, compliance and software requirements used to adjudicate claims * General knowledge of office procedures and methods * Strong organizational skills * Excellent oral and written communication skills with the ability to understand oral and written instructions * Excellent computer skills including use of Microsoft Office products * Ability to handle large volume of work and to manage a desk with multiple priorities * Ability to work in a team atmosphere and in cooperation with others and be accountable for results * Ability to read printed words and numbers rapidly and accurately * Ability to enter routine and repetitive batches of data from a variety of source documents within structured time schedules * Ability to manage and uphold integrity and confidentiality of sensitive data   Education and Experience Required: High School graduate or equivalent and three (3) years of experience in claims reimbursement in a healthcare setting; or an equivalent combination of education and experience.   Education and Experience Preferred: N/A Licensure/Certification Requirements: N/A