Claims Specialist

Job Details

Description

Harbor is seeking a Claims Specialist to join the Toledo team! This position works collaboratively with internal and external customers to obtain, update, submit, and interpret client account information.

Position is full-time, 40 hours per week.

Education/Experience/Other Requirements

• Associates Degree in Healthcare Administration or related field or 3 years Revenue cycle experience preferred.
• Demonstrated knowledge and understanding of health/behavioral health billing procedures and eligibilities for third-party providers preferred.
• Knowledge of governmental and commercial insurance rules and regulations.
• Must have strong attention to detail.
• Previous coding experience in a behavioral healthcare setting preferred.
• Excellent communication and interpersonal skills.
• Must be able to establish daily work priorities and work independently and efficiently to meet deadlines.
• Must be honest, dependable, self-disciplined, organized and be able to work well as a team member.
  
  

Essential Job Competencies/Primary Duties

• Works collaboratively with the team to identify and complete projects with Revenue Cycle team.
• Receives incoming questions from clients, payers and/or clinicians regarding client accounts; initiates data submission for any additional information needed, and interprets information back to the client, payer and/or clinician.
• Verifies insurance coverage, co-payment, and coordination of benefits and updates client billing information accordingly.
• Reviews, monitors, updates and ensures timely submission and follow up for payer authorizations.
• Initiates denials process, including appeals and status requests.
• Identifies and tracks denial trends, using both the organizations EHR system and clearinghouse to create robust denial prevention processes.
• Participates, leads and initiates conversations with payers about matters with complex claims and reimbursement policies.
• Uses denial tracking as a tool to recognize opportunity within the department and facilitates additional staff training, and/or new workflow ideas to reduce overall denial rate.
• Provides coverage for claim submission and clearinghouse rejections when needed.
• Maintains current knowledge regarding public payers, third-party and first-party payment procedures and regulations.
• Monitors dashboard and runs reports daily to monitor and initiate corrective actions as necessary to ensure accuracy and completeness of billing, service and charge information for timely submission.
• Reviews charges for accuracy and follows up timely on claim generation errors.
• Keeps current with trends and developments related to essential job competencies and demonstrates continued growth.
  
  

About Harbor

• A leading provider of mental health and substance use treatment for over 100 years
• 350+ clinical staff serve over 24,000 clients across multiple locations and in the community each year
• Services ranging from counseling, pharmacological management, primary care, psychological testing, case management, substance use treatment, residential services, vocational program, and more!
  
  

Why Work for Harbor?

Benefits

It is fast-paced and challenging, but you will have a lot of fun in the process. You will have the opportunity to meet other motivated individuals who are also making a positive impact at our company. Harbor is committed to investing our resources in you! Some benefits of working with Harbor include:

• Medical, dental, and vision coverage
• Retirement plan with company match
• Generous paid time off, sick time, and paid holidays
• Tuition and professional license reimbursement programs
• Clinical supervision hours offered
• Employee referral bonuses
• Ability to make a difference in your community!