Northpoint Recovery · 17 hours ago
Claims Escalation & Denials Appeals Specialist
Meridian, ID
Full-time
Hybrid
Entry, Mid Level
$21/hr - $24/hr
2+ years expNorthpoint Recovery Holdings, LLC is a leading behavioral healthcare provider offering evidence-based treatment for adults with substance use and co-occurring disorders. The Claims Escalation & Denials Appeals Specialist plays a key role in the Revenue Cycle Management team, responsible for managing collections, denial management, and accounts receivable for assigned accounts, ensuring timely payments from insurance companies for services rendered.
Health Care
Responsibilities
Perform collections to ensure receipt of medical claims within twenty-eight (28) days
Make outbound telephone calls to insurance companies, and utilize payer portals for claims resolution
Coordinate with insurance companies to ensure timely payment for services rendered
Follow existing billing and collection protocols to ensure accurate and timely reimbursement
Review accounts receivable accounts to ensure accurate reimbursement and identify payer issues affecting payment delays
Contact payers to get a clear understanding of denials and changes needed to receive payment
Prepare appeals, when necessary, when claim denials are payer errors
Document all correspondence with payers in the billing system
Collaborate and coordinate with Utilization Review for prior authorization/medical necessity documentation
Knowledge of CMS and Third-party payer regulations and guidelines
Thorough understanding of Explanation of Benefits
Maintain accurate records of patient billing and payment information
Provide reports to management on outstanding balances and collections activity
Provide excellent communication and customer service skills
Utilize a strong understanding of insurance billing and coding requirements
Maintain active working knowledge of Northpoint billing and reimbursement requirements by payer
Collaborate with RCM team and other departments to ensure successful execution of assigned duties and priorities
Maintain confidentiality in accordance with established policies and procedures and standards of care
Adhere to all Company policies and procedures
Perform other job-related duties as assigned
Qualification
Required
2+ years of collections, billing reimbursement, payer relations, or medical Accounts Receivable required
Experience in a healthcare or behavioral health system with multiple levels of care preferred
Experience working with commercial medical insurance billing, as well as Medicaid, claims submission, and the technical aspects of billing software
All-in-one practice management, clearing house and billing software required
Proficient in navigating through payer portals
Must be proficient in CPT, HCPCS, and ICD-10 Codes, DSMS and ASAM criteria, data entry for various third party billing and payers, and their reimbursement and denial patterns
Ability to work well in a team environment, with ability to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion
Problem-solving skills to research and resolve discrepancies, denials, appeals, collections
Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems required
Strong organizational skills with the ability to multitask
Meticulous attention to detail and high level of accuracy is key
Demonstrated ability to develop both internal and external working relationships
Proven skills in working independently on several projects concurrently
Preferred
Experience in a healthcare or behavioral health system with multiple levels of care preferred
KIPU or similar EHR/EMR experience preferred
Sense of ethics, integrity, and confidentiality about employee and business issues
Ability to work independently and within a dynamic team environment
Maintain professional and technical knowledge
Excellent critical thinking skills and organizational abilities
Excellent communication skills; ability to communicate clearly and concisely, verbally and in writing
Quickly and effectively identify and resolve problematic situations
Comfortable analyzing information and dealing with complexity
Attention to detail and accuracy
Able to handle confidential material in a reliable manner
Ability to interact and communicate with individuals at all levels of organization
Ability to perform several tasks concurrently with ease and professionalism
Ability to effectively prioritize workload in a fast-paced environment
Proficiency with Microsoft Office Suite
Benefits
Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s)
100% Employer Paid Basic Life Insurance equal to 1x annual salary, up to $100,000
100% Employer Paid Employee Assistance Program
Voluntary Dental, Vision, Short-Term Disability, Supplemental Life & AD&D, Critical Illness, Accident, and Hospital Indemnity Insurance.
Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses
Generous Paid Time Off plan
Employee Referral Bonuses
401K Retirement Plan & Employer Match
Company
Northpoint Recovery
Northpoint Recovery is specialized drug and alcohol detox and rehab treatment center located in Southwestern Idaho.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2016-01-01Acquired
Leadership Team
Stokes Aitken
Chief Executive Officer
Recent News
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