CLAIM SPECIALIST I

The CLAIM SPECIALIST I, reporting directly to the Billing Director, will join our Billing Department to be an integral part of our mission to provide culturally sensitive behavioral health, substance use, preventative, and educational services to more than 15,000 adults, children, and families.

Essential Duties/Responsibilities

• Performs the electronic file transfer for all insurances.
• Processes and prepares paper claims for primary and secondary insurance submissions.
• Manages and post payments and denials from insurance remittances, as well as processes and post adjustments and denials as noted by contracts.
• Investigates and reports denials and denial trends.
• Reviews and works aging reports.
• Compiles data and reports as requested by the Billing Director.
• Occasional driving to Outpatient clinics on an as-needed basis.
• High attention to detail and accuracy
• Ensures compliance with local, state, and federal government requirements.
• Performs other related duties as necessary or assigned.
• Experience in interpreting, communicating, and administering federal, state, and local laws, regulations, and policies involving the operation of programs and services for persons with mental health, intellectual disability, and substance use disorders.
• Bicultural competence of multiple cultural groups.

ESSENTIAL JOB DUTIES

• Builds consensus among parties with differing viewpoints to obtain a working agreement. Maintains productivity standards relative to the requirements of the position.

• Observes all HIPPA rules of confidentiality as it relates to client information, both internally and in dealing with external individuals and/or agencies and all the state agencies, regulatory or professional guidelines and practices.

Required Skills

Skills/Abilities

• Excellent written and verbal communication skills.
• Excellent organizational and time management skills.
• Proficient in Microsoft Office Suite or similar software.
• Proficient CareLogic or other Health Records systems.

Education and Experience

• Minimum high school diploma with emphasis on business-related courses.
• Thorough knowledge of billing practices and managed care requirements. Must have knowledge of CPT and ICD-10 codes.
• Working knowledge of behavioral health management practices and clinical operations.

WORKING CONDITIONS

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.              

BENEFITS

• Retirement Plan 403(b)
• Health, Dental, Vision, and Life Insurance
• Paid vacations
• Paid holidays
• 8 discretionary days a year

The Gandara Mental Health Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Gándara Mental Health Center is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. The Gándara Mental Health Center is also committed to compliance with all fair employment practices regarding citizenship and immigration status.

Required Experience

Skills/Abilities

• Excellent written and verbal communication skills.
• Excellent organizational and time management skills.
• Proficient in Microsoft Office Suite or similar software.
• Proficient CareLogic or other Health Records systems.

Education and Experience

• Minimum high school diploma with emphasis on business-related courses.
• Thorough knowledge of billing practices and managed care requirements. Must have knowledge of CPT and ICD-10 codes.
• Working knowledge of behavioral health management practices and clinical operations.

WORKING CONDITIONS

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.              

BENEFITS

• Retirement Plan 403(b)
• Health, Dental, Vision, and Life Insurance
• Paid vacations
• Paid holidays
• 8 discretionary days a year

The Gandara Mental Health Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Gándara Mental Health Center is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. The Gándara Mental Health Center is also committed to compliance with all fair employment practices regarding citizenship and immigration status.