Claims Specialist

Vista Del Mar • Los Angeles, CA

13d • $21 - $23

About The Position

The Claims Specialist - Quality Standards and Compliance (QSC) manages client information and funding eligibility of clients billed through the Los Angeles County Department of Mental Health (DMH) contract. Will be responsible for opening and updating client information in the Client Web Services (CWS) application, and for reviewing service claims submitted to the DMH’s Integrated System Website, IBHIS.

Requirements

• Background of education and/or experience in an office setting equivalent to a college education
• Experience with insurance and submitting mental health claims
• Must have good organizational skills and the ability to work cooperatively with others.
• Advanced computer skills.

Nice To Haves

• previous experience with Department of Mental Health contracts a plus

Responsibilities

• Verifies funding eligibility status of DMH clients at admission and on a monthly basis, and maintains financial information in client’s TIER file and financial file. Disseminates any changes to programs and consults on any updates of funding eligibility
• Daily, checks admissions and discharges in TIER, reviewing client’s administrative face sheet to ensure that data is complete. Maintains an organized system of assigned program’s clients to be able to track the status of needed information and ensure there is follow-up with programs as needed
• As new clients are ready to be billed, reviews the IBHIS face sheet and financial information sent by programs to ensure that all information is accurate and complete in TIER. Submits all call information to Client Web Services (CWS)
• Daily, reviews non-final saved charges in TIER for any corrective action needed. Completes any updates or corrections required, and manually updates services charges and ‘final save’ so that claims can be batched
• Daily, reviews Diagnosis and Financial Update Reports and Client Action Forms submitted for any client information that requires updating in CWS. If TIER data is complete, submits the call to update CWS
• Monthly, runs Non-Final Saved Notes reports for programs assigned, reviews notes for action required., and disseminates to programs
• Reviews Final Saved Charge reports before batching claims for electronic submission to DMH. Ensures that claims are submitted to the correct funding source, all claim data is accurate, and has been collected.
• Batches together all reviewed claims and submits to DMH’s IBHIS website. Monitors the receipt of claims by IBHIS for any rejected claims, and follows necessary protocols to fix the rejected claims and resubmit them.

Benefits

• Full benefits offered (Medical, Dental, Vision)
• FSA/Dependent Care FSA and Supplemental benefits
• 403(b) – 3% Employer contribution based off annual salary
• 4 Mental Health Days
• Up to 12 Paid Holidays
• Up to 25% for Cell Phone Discounts with 3 Major Carriers (AT&T, Verizon, Sprint)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed