All In Solutions, LLC · 1 day ago
Claims Resolution Specialist - Substance Abuse Treatment Operations
Boynton Beach, FL
Full-time
Onsite
New Grad, Entry Level
$45K/yr - $55K/yrAll In Solutions is dedicated to providing quality, evidence-based treatment for long-term recovery. The Claims Resolution Specialist will manage and resolve claims issues, ensuring compliance and accuracy in billing for substance abuse treatment services.
Business DevelopmentInformation TechnologyIT Management
Responsibilities
Identify, analyze, and resolve denied or rejected claims by reviewing insurance EOBs and remittance advice
Draft and submit formal appeals for "medical necessity" denials, utilizing ASAM or DSM-5 criteria to justify patient levels of care
Actively manage the Accounts Receivable aging report to ensure all claims over 30 days are investigated and resolved
Audit initial Verification of Benefits (VOB) to ensure billing alignment with the patient’s specific mental health/substance abuse coverage
Perform data entry corrections for "clean claim" submissions, including ICD-10-CM, HCPCS, and CPT codes
Investigate and resolve primary/secondary payer conflicts to ensure the correct order of insurance liability
Cross-reference billed dates of service against Utilization Review (UR) authorizations to prevent "no-auth" denials
Stay current on evolving insurance medical policies regarding Substance Abuse and Behavioral Health
Monitor insurance payments against contracted rates to identify and dispute underpayments
Identify overpayments and process insurance refunds or offsets in accordance with compliance standards
Troubleshoot electronic claim-submission errors and "front-end" rejections within the clearinghouse portal
Ensure all claims activities adhere to HIPAA privacy regulations and the Mental Health Parity and Addiction Equity Act (MHPAEA)
Provide management with weekly reports on collection rates and identify patterns in payer behavior or high-volume denial reasons
Qualification
Required
Familiarity with regulatory requirements: NJ: NJAC 10:161A/B – Billing compliance for SUD facilities, FL: FAC 65D-30 – Billing documentation and reporting requirements, CA: Title 9 CCR, Chapter 11 – SUD billing and recordkeeping
Exceptional attention to detail and an eye for spotting errors and discrepancies
Strong communication and customer service skills with the ability to see issues through to resolution
Intermediate to advanced levels of skills in Google Suite and/or Microsoft Office and a proven aptitude for computers
Strong understanding of current ICD-10, CPT and HCPCS coding practices
Familiarity with HIPAA privacy laws and the Mental Health Parity and Addiction Equity Act (MHPAEA)
Preferred
Preferred understanding of ASAM (American Society of Addiction Medicine) criteria and how it relates to billing levels of care
Experience with Kipu and CollaborateMD
Benefits
401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance
Company
All In Solutions, LLC
All In Solutions, LLC is an SBA certified SDVOSB, and WOSB specializing in IT Managed Services Delivery (MSD), and Problem Exploration and Solutioning in an integrated approach across the areas of people, process and technology.
Founded in 2015
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Allison Hickey
CEO/ President
Company data provided by crunchbase