Claims Processor

Saginaw County Community Mental Health Authority • Saginaw, MI

70d • $21 - $25

About The Position

Under the general supervision of the Chief of Network Business Operations, this position will have the primary responsibility of processing provider network and hospital claims for payment. This position requires claims coordination of benefits (COB) experience ensuring all third-party insurance carriers have been appropriately billed prior to Saginaw County Community Mental Health Authority (SCCMHA) claims payment. The tasks of this position have monthly claims batch payment deadlines, which are coordinated with the other staff within the accounting department. This position must maintain current knowledge of regulations pertaining to approved CPT/HCPCS and Revenue Codes, methods of billing, and procedures related to Medicaid/Medicare and various unique Commercial Insurance reimbursements rules. This position will be knowledgeable about and actively support culturally competent recovery based practices; person centered planning as a shared decision making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid consumer in the recovery process.

Requirements

• Associate Degree with healthcare related courses required.
• Medical terminology and medical billing college level courses required.
• Three (3) years of healthcare claims processing (including coordination of benefits) experience required.
• Valid Michigan Driver’s license with a good driving record.

Nice To Haves

• Professional knowledge of and ability to use computerized accounting software such as Great Plains.
• Proficiency in Microsoft Office including Word, Excel, Access, and Outlook.
• Comprehensive knowledge of the billing processing working with an Electronic Medical Records Healthcare System.
• Knowledge of medical terminology and medical procedures associated with clinical billing codes.
• Ability to communicate well with others and occasionally deal with irate individuals.
• High degree of attention to detail.
• Ability to diplomatically associate and relate to individuals of all social, economical, and cultural backgrounds.
• Must be skilled in normal office procedures such as written and verbal correspondence and use of calculator and other office machines.
• Maintaining a current knowledge of regulatory policies, procedures, and reporting will be required.

Responsibilities

• Coordinate and adjudicate paper and electronic claims submitted by the provider network and hospitals for payment in accordance with policies and procedures.
• Approve clean claims for payment. Assist as applicable with denied claims. Submit overrides for approval when appropriate.
• Verify authorizations as they pertain to proper coding, dating, and fund source.
• Review coordination of benefits documents prior to claims payment.
• Verify the Explanation of Benefits submitted by the Provider matches the Coordination of Benefits information on file for the consumer.
• Ensure reason codes are reasonable. Follow-up with provider as necessary to resolve discrepancies.
• Process Event Verification settlements following Network Service Auditing review.
• Process retro payments when contracted rates are modified.
• Verify all the backup for each provider check/EFT is an agreement prior to mailing the payment.
• Research, compile and prepare claim(s) remittance reports and other statistical data.
• Reconcile provider explanation of benefits (EOB) back to the claims detail.
• Interpret provider contract rates and requirements as they pertain to claims payment and provider benefit packages.
• Help to establish and implement ongoing improvements to procedures for claims processing.
• Answer telephones/work with providers to obtain timely, accurate and complete claims data.
• Train providers or other staff when needed of proper SCCMHA claims processing requirements.
• Enter daily CTN/CTS skill build SALs into Sentri based on daily attendance calendars submitted by the respective programs.
• Reconcile the SALs to the CTN/CTS attendance sheets.
• Process consumer Ability to Pay (ATP) based upon CFIS documents.
• Enter consumer ATP’s data into Sentri.
• Perform insurance verification as applicable.
• Provide backup and other miscellaneous duties as assigned.
• Adheres to the mission, vision, core values and operating principles of SCCMHA at all times.

Benefits

• $21.85 - $25.69 Hourly

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree
• Number of Employees: 251-500 employees