All In Solutions, LLC · 8 hours ago
Denials 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 Denials Specialist is responsible for investigating and resolving denied insurance claims to maximize revenue for behavioral health services, utilizing their expertise in mental health parity and medical necessity criteria.
Business DevelopmentInformation TechnologyIT Management
Responsibilities
Systematically review Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) to identify the specific reason for every claim denial
Collaborate with the clinical team to draft highly detailed appeals using ASAM or DSM-5 criteria to combat "lack of medical necessity"; denials
Prioritize and manage a high-volume queue of outstanding claims, focusing on high-dollar denials and those approaching timely filing deadlines
Maintain a comprehensive database of payer-specific medical policies, specifically regarding behavioral health benefits and restrictions
Identify and fix "front-end"; errors such as incorrect CPT/HCPCS codes, and ICD-10-CM codes
Cross-verify billed dates of service against internal Utilization Review (UR) records to ensure all services rendered were properly authorized
Resolve complex billing issues where multiple insurance carriers are involved or where patient eligibility has changed mid-treatment
Monitor insurance payments to ensure they align with the facility’s contracted rates, initiating disputes for any discrepancies
Manage the transmission of claims through the electronic clearinghouse and resolve any EDI (Electronic Data Interchange) rejection loops
Aggregate denial data to identify "blacklisted"; codes or systemic payer issues, reporting these patterns to the Director of Revenue Cycle
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