Behavioral Health Network Claims Analyst in Springfield, Massachusetts
Claims Analyst, Springfield General Information Job Title: Claims Analyst Location: 417 Liberty Street Springfield, MA, 01104 Employee Type: Full-Time Job Category: Financial, Fiscal, Supervisor Required Degree: 2 Year Degree Description Join our team of competent and compassionate professionals as a Claims Analyst in the Billing Department at Behavioral Health Network! Claim Analysts include maximizing capabilities of claims editing tools and determining pre-payment and post-payment solutions that identify and recover inappropriate claim payments and overpayments. The Claims Analyst provides actionable intelligence for systematic improvements to improve accuracy, lower costs, and improve provider satisfaction. Conduct investigations of potential healthcare fraud, abuse, or waste as well as conducting in-depth simple to complex claim audits. Analyzes and resolves complex issues on claims identified, which includes eligibility of the client, delving into patient medical history, validation of medical coding, and interpretation of plan/policy provision and pricing arrangements. Conducts in-depth research and analytics of claims data to identify trends and emerging issues on provider billing errors and fraudulent submitting claims and prepares detail reports with recommendation of best practices. Assists with development and implementation of action plans for procedure and workflow improvement. Mentors and trains new and/or existing team members on procedures, workflow, analysis and trending, reports, and other related information. Tracks processing inefficiencies to analyze trending for specific claim types, providers, processors, plans, and processing error types to provide more meaningful insight into recurrent problem areas and provides recommendations for corrective action. Assists with enrollment of new sites and programs. Acts as a resource to other staff. Assists Fiscal team with any reports needed. Acts as a liaison between the Billing department and programs, vendors, and provider representatives, and establishes and maintains relationships to improve dialog and processes. This may be accomplished through the coordination of meetings with all representatives. Reasons to work with BHN: Work with an agency who does amazing things for others You will be able to change a person's life You will expand your experience in various health areas at the same time You will have the opportunity to grow within the agency You will not be bored with our fast-paced environment You will have excellent benefits package & time off benefits available What are we looking for in a Claims Analyst? Associate's Degree or equivalent (coding certification) required. At least five (5) years overall revenue cycle experience. Minimum of two (2) years of analytical skills. Ability to manage multiple concurrent activities. Ability to either use or learn computer applications as applicable to the role: (Carelogic, Ability, Excel, VLOOKUPs, pivot tables,) Ability to schedule, meet, and maintain daily and monthly routines, as well as preserve the integrity of the EHR. Must have strong knowledge of (Behavioral Health and Substance Use Disorder) medical insurance billing and collections with CPT, ICD10, and HCPC coding and medical terminology, as well as an overall understating of managed care products (HMO, PPO, etc.). Must possess excellent analytic and problem-solving skills. Extensive knowledge of behavioral health and substance use disorder billing and reimbursement process. Ability to become proficient on all processes surrounding adjudication of Behavioral Health and Substance Use Disorder claims and member eligibility. Remote work from home opportunity. Ability to accept responsibility for medium to large scale projects involving multiple resources and spanning many months from start to finish. Ability to communicate root cause and recommendations to Management.