SUMMARY

This position will work with EOBs, accounts receivables, aging, cash applications, self-pay, authorizations and all phases of billing for a behavioral health/substance use clinic. In addition, this position will have a primary focus on self-pay accounts, processing day rate third party billing for residential recovery programs, handle denials and DPH funding requirements.

PRIMARY RESPONSIBILITIES

• Primary role is to serve billing requirements for Serenity House, Sage House, Rhodes House and Serenity II programs, handle monthly day rate process.
• Reconcile claims for residential programs, and work with case managers to ensure proper data entry of client information for current payers.
• Set up payment processes as new payers come online for residential programs,
• Notify clinicians when additional visits and/or prior authorizations are needed.
• Enter new client basic demographic information into billing system, as well as entering insurance and authorizations.
• Post insurance checks and EOBs and reconcile posted totals.
• Resolve claim denials, reconcile and resolve issues related to claims submissions.
• Submit claims to payers, electronically or in paper form and verify receipt and acceptance by payers.
• Follow up on self-pay accounts, running reports, sending out self-pay paperwork to clients and taking client calls to discuss balances and payment plans.
• Attend & participate in engagement team meetings, follow up with client service plans and communicate effectively with clients and staff in other specialty areas.
• Ensure compliance with program/department, agency and/or funder requirements, as well as SMOC policies & procedures.
• Other duties as assigned.

KNOWLEDGE AND SKILL REQUIREMENTS

• Medical and/or Mental Health third party billing experience required min 3+ years required.
• Must have ability to handle multiple and changing priorities and meet deadlines.

ORGANIZATIONAL RELATIONSHIP