Claims Escalation & Denials Appeals Specialist

Northpoint Recovery Holdings•Meridian, ID

19h•Remote

About The Position

As a key member of the Revenue Cycle Management team, the Claims Escalation & Denials Appeals Specialist manages collection, denial resolution, and accounts receivable for assigned accounts. The role is responsible for collecting outstanding insurance balances for services provided to Northpoint patients and clients, working with patients, insurers, and Northpoint providers to support timely payment, and following payer denials and rejections through to resolution or payment. The position requires an understanding of the patient billing lifecycle, including verifications, pre-authorization, utilization review, appeals, claims submission and adjudication, and denials, as well as insurance guidelines and payer systems. This is a remote, full-time position scheduled Monday through Friday, 8 a.m. to 5 p.m. Mountain Standard Time. It reports to the Corporate Director of Revenue Cycle Management. Compensation is $22–$24 per hour. Northpoint Recovery Holdings is a behavioral healthcare provider offering substance use and co-occurring disorder treatment for adults and mental health treatment for adolescents. Employees must follow company policies and procedures and protect confidential information, including protected health information in accordance with HIPAA. Full-time benefits include subsidized health insurance for the employee and eligible family members; employer-paid basic life insurance and an Employee Assistance Program; voluntary dental, vision, disability, supplemental life and AD&D, critical illness, accident, and hospital indemnity insurance; pre-tax savings accounts for eligible medical and dependent-care expenses; paid time off; employee referral bonuses; and a 401(k) retirement plan with employer match.

Requirements

At least 2 years of experience in collections, billing reimbursement, payer relations, or medical accounts receivable.
Experience with commercial medical insurance billing, Medicaid, claims submission, and technical aspects of billing software.
Experience using all-in-one practice management, clearinghouse, and billing software.
Proficiency navigating payer portals.
Proficiency in CPT, HCPCS, and ICD-10 codes, DSMS and ASAM criteria, and data entry for third-party billing and payers, including knowledge of reimbursement and denial patterns.
Knowledge of insurance guidelines, including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
Ability to work effectively on a team, triage priorities, delegate tasks when needed, and handle conflict reasonably.
Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections.
Strong organizational skills and ability to multitask and manage concurrent priorities.
Meticulous attention to detail and accuracy.
Ability to develop internal and external working relationships and work independently on multiple projects concurrently.
Strong communication and customer service skills, including clear and concise verbal and written communication.
Ability to prioritize workload in a fast-paced environment and handle confidential material reliably.
Proficiency with Microsoft Office Suite.
Compliance with procedures and guidelines governed by HIPAA when accessing protected health information.

Nice To Haves

Experience in a healthcare or behavioral health system with multiple levels of care.
KIPU or similar EHR/EMR experience.
Ethics, integrity, and discretion regarding employee and business issues.
Ability to maintain professional and technical knowledge.
Strong critical-thinking skills and organizational abilities.
Ability to identify and resolve problematic situations quickly and effectively.
Comfort analyzing information and dealing with complexity.
Ability to communicate and interact with people at all levels of the organization.
Ability to perform several tasks concurrently with professionalism.

Responsibilities

Perform collections to help ensure receipt of medical claim payments within 28 days.
Call insurance companies and use payer portals to resolve claims.
Coordinate with insurers to support timely payment for services rendered.
Follow billing and collection protocols to ensure accurate and timely reimbursement.
Review accounts receivable accounts for reimbursement accuracy and identify payer issues causing delays.
Contact payers to understand denials and determine changes needed to obtain payment.
Prepare appeals when claim denials result from payer errors.
Document payer correspondence in the billing system.
Coordinate with Utilization Review regarding prior authorization and medical-necessity documentation.
Maintain knowledge of CMS and third-party payer regulations and guidelines, and understand explanations of benefits.
Maintain accurate patient billing and payment records.
Report outstanding balances and collection activity to management.
Provide effective communication and customer service.
Maintain working knowledge of Northpoint billing and payer-specific reimbursement requirements.
Coordinate with the Revenue Cycle Management team and other departments to execute assigned duties and priorities.
Maintain confidentiality in accordance with company policies, procedures, and standards of care.
Follow company policies and procedures and perform other job-related duties as assigned.

Benefits

Subsidized health insurance coverage for the employee, spouse, and dependents.
Employer-paid basic life insurance equal to one times annual salary, up to $100,000.
Employer-paid Employee Assistance Program.
Voluntary dental insurance.
Voluntary vision insurance.
Voluntary short-term disability insurance.
Voluntary supplemental life and AD&D insurance.
Voluntary critical illness insurance.
Voluntary accident insurance.
Voluntary hospital indemnity insurance.
Pre-tax savings accounts for eligible medical and dependent-care expenses.
Paid time off plan.
Employee referral bonuses.
401(k) retirement plan with employer match.