Claim Specialist

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    "requisitionDescription": "<div><div><p data-start=\"418\" data-end=\"700\" data-pasted=\"true\">Looking for an experienced Behavioral Health Claims Follow-Up Specialist to join our Revenue Cycle team. This role is responsible for managing insurance claims follow-up, resolving denials, and ensuring timely reimbursement across commercial and workers&rsquo; compensation payers.</p><p data-start=\"702\" data-end=\"877\">The ideal candidate is detail-oriented, proactive, and experienced in behavioral health billing workflows, including claim corrections, payer communication, and AR resolution.</p><p><strong>Responsibilities:</strong></p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Claims Processing: Review and process incoming claims for accuracy, completeness, and compliance with policies and regulations.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Claims Evaluation: Evaluate and assess the validity of claims based on established guidelines, reviewing medical records, police reports, and other relevant documentation.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Claims Payment: Coordinate with the finance department to ensure timely and accurate claims payments.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span> Investigation and Resolution: Investigate complex claims, including fraud prevention and risk analysis, and resolve any discrepancies or issues in a timely manner.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Documentation: Maintain detailed and accurate records of claims processed, including all correspondence and supporting documentation.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Compliance: Ensure all claims are processed in accordance with company policies, industry standards, and legal requirements.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span> Reporting: Provide regular reports on claims status, processing times, and claim trends to management.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Any other duties as assigned by department</p><p><strong>Minimum Requirements:</strong></p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Experience: Minimum of 2-3 years of experience in claims processing or a related field.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Knowledge: Understanding of insurance policies, claims procedures, and industry regulations.</p><p><strong>Competencies:</strong></p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Detail-Oriented: Ability to carefully evaluate and manage claims with a high degree of accuracy.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Problem-Solving Skills: Strong analytical and problem-solving skills to address and resolve issues in claims.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Technical Skills: Proficiency in MS Office (Word, Excel, Outlook) and claims management software (e.g., Guidewire, VUE, etc.).</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span>Customer Service: Ability to deliver excellent customer service and resolve issues in a timely manner.</p><p>&bull;<span style=\"white-space:pre;\">&nbsp; &nbsp;&nbsp;</span> Time Management: Strong organizational and time-management skills, with the ability to handle multiple tasks efficiently.</p><p><br></p></div></div>\n",
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