Claims Administrator

Community Health Alliance-Ohio•Fairfield, OH

1d•Hybrid

About The Position

Are you looking for a career where you can make a difference in the lives of individuals in recovery for mental health and substance use disorders? Do you thrive in a healthy and collaborative work environment where you can grow personally and professionally? JOIN OUR TEAM of dedicated professionals in fostering hope and transforming lives. We are seeking an experienced Claims Administrator to join our team. In this role, you will be responsible for configuring and maintaining billing functionalities within the EHR system. You will collaborate with healthcare providers, billing staff and CareLogic Administrators to ensure accurate billing processes, compliance with regulations and seamless integration with financial systems. Develop a career dedicated to connection, compassion, and community. Community Health Alliance is an employer that offers career opportunities with purpose. At Community Health Alliance our employees are our greatest asset. We offer a comprehensive benefit program designed to support you and your family. Community Health Alliance is a leader providing the highest industry standards for health and human services. Our agencies of Sojourner Recovery Services and TLC offer a complete continuum of mental health and substance use treatment services. We equip our patients with the resources, services, and tools they need to achieve their goals and reach their highest personal potential. Community Health Alliance is proud to play a key role in helping individuals achieve a brighter and healthier future. Through innovation, integration, and collaboration of our agencies, the Community Health Alliance strengthens and empowers the individuals, families, and communities we serve.

Requirements

High school diploma or GED required.
Minimum of 3 years of healthcare billing experience using EHR systems.
Proven experience as a Billing Specialist in a healthcare setting.
Solid understanding of CPT, ICD, and HCPCS coding and medical terminology.
Experience with Medicare and Medicaid billing regulations.
Familiarity with contractual adjustments, sequestration, and payment posting/balancing.
Strong knowledge of healthcare and behavioral health billing workflows and regulations.
Proficiency with EHR systems, billing software, and Microsoft Office (especially Excel).
Demonstrated ability to manage relationships with multiple insurance payers.
Strong working knowledge of billing compliance and reimbursement methodologies.

Nice To Haves

Certified Professional Coder (CPC), Certified Professional Biller (CPB) or Certified Billing and Coding Specitalist 9CBCS) preferred.

Responsibilities

Maintain and configure all CareLogic billing administration (funders, EDI, modifiers, procedure codes, rate tables).
Test and validate billing functionality (cert environment) to support funder changes and new services.
Ensure billing setup accuracy, compliance, and data integrity through ongoing testing and QA.
Monitor, submit, correct, and resubmit claims (EDI and manual), including clearinghouse rejections.
Review failed/denied claims and assign follow-up to billing specialists as needed.
Coordinate with Finance to ensure accurate revenue reporting and error-free GL cost center reporting.
Audit claim activity and ensure timely invoicing, including self-pay.
Design, test, and maintain billing reports and metrics (CareLogic BI and interim solutions).
Run monthly patient statements, manage write-offs, and distribute client balance reports.
Maintain SharePoint and billing documentation; stay current on billing regulations and funder requirements.