Lead Reimbursement Specialist - Behavioral Health 901

Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals with complex needs in recovering their health, hopes, and dreams.

Telecare continues to advance cultural diversity, humility, equity, and inclusion at all levels of our organization by hiring mental health peers, BIPOC, LGBTQIA+, veterans, and all belief systems.

Full Time; AM : am - : pm; Monday - Friday

Expected starting wage range is $, - $, Telecare applies geographic differentials to its pay ranges. The pay range assigned to this role will be based on the geographic location from which the role is performed.

Starting pay is commensurate with relevant experience above the minimum requirements.

POSITION SUMMARY

The Lead Reimbursement Specialist is responsible for all revenue cycle functions for assigned fee for service / third party facilities, including insurance verification, census, authorization management, billing, collections, cash posting, collections, denials, appeals and write offs / refunds.

Additionally, the Lead Reimbursement Specialist serves as the main help contact for the Reimbursement Specialists in their group.

Including providing support during contract / payer changes, trains new staff and reviews work of new staff. Keeps up to date on all applicable CPT and other coding changes, fee for service and / or contract billing rates and communicates those changes to all affected parties at Telecare.

There may be some travel to locations where Telecare does business or plans to do business.

QUALIFICATIONS

Required :

• Six () years of full cycle revenue cycle experience and extensive knowledge of Medicare, Medi-Cal / Medicaid and commercial insurances
• A high level of PC literacy, especially in Excel and Word
• Prior experience training staff, using exceptional communication skills
• Critical thinking and data validation skills are mandatory
• Ability to identify and escalate issues and conflicts to management timely
• Understanding of accounting principles and the ability to balance detailed accounts to the general ledger
• The ability to operate independently, handle multiple tasks simultaneously and complete assignments with minimal supervision.
• Demonstrated capacity to work with sophisticated automated billing systems
• Must be at least years of age
• All opportunities at Telecare are contingent upon successful completion and receipt of acceptable results of the applicable post-offer physical examination, -step PPD test for tuberculosis, acceptable criminal background clearances, excluded party sanctions, and degree or license verification.

If the position requires driving, valid driver license, a motor vehicle clearance and proof of auto insurance is required at time of employment and must be maintained throughout employment.

Additional regulatory, contractual or local requirements may apply

Preferred :

Bachelor’s or AA degree

ESSENTIAL FUNCTIONS

• Demonstrate the Telecare mission, purpose, values and beliefs in everyday language and contact with the internal and external stakeholders
• Assists in developing the overall philosophy and objectives of accounts receivable services in accordance with the corporate mission
• Serves as main point of contact for Single Case Agreements that need to be negotiated for the programs in assig billing group
• Responsible for performing and / or knowing all the billing and collection activities for assigned programs, ensuring timely and accurate billing including :
• Confirm census, financial eligibility, authorizations
• Complete paper and / or electronic billing to multiple payers
• Post payments, manually and electronically
• Identify under / overpayments and process refunds
• Respond to claim denials timely
• Run aging reports for collection call identification and complete collection calls and follow up note entry
• Identify bad debt and complete write off requests
• Identify / complete billing adjustment
• Client statements
• Complete month end reconciliation
• Collaborates with Billing Manager in strategic planning or development activities with the goal of ensuring ongoing effective billing and reimbursement
• Active member of the Financial Review Committee, creating the agenda and leading the discussions about the pending receivables
• Keeps Billing Manager informed of status of account receivable for the billing unit
• Mentors new staff in the billing group and performs majority of staff training
• Promotes and maintains harmonious and effective relationships and communications within the department, with other departments, with government representatives and with customers
• Consistently updates knowledge of regulations, procedures and standards to assure compliance with contractual obligations and directives from governmental and regulatory agencies, fiscal intermediaries and contracting entities
• Reviews month end packets for Reimbursement Staff in billing group corrects errors with staff as necessary
• Provides technical support and oversight of third party reimbursement functions performed at the program level, especially for new programs
• Works with the Billing Manager to implement and maintain written policies and procedures so that the appropriate submission, billing and payment cycle of client accounts are maintained
• Actively participates in meeting customer needs and adapting to changing customer needs at all times
• Participates as a Revenue Cycle Department member and provides input via reporting observations, concerns and asking appropriate questions
• Appropriately applies rules and regulations in preparation of billings
• Follows proper internal controls

Duties and responsibilities may be added, deleted and / or changed at the discretion of management.

SKILLS

• High level of computer literacy
• Exceptional attention to details with a high degree of critical thinking
• Other necessary skills include analytical and problem solving skills, the ability to understand complex reimbursement structures and governmental regulations and the ability to work and communicate effectively with program staff, management staff, government representatives and customers

PHYSICAL DEMANDS

The physical demands here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

The employee is constantly required to sit and occasionally required to stand, walk, reach, twist, bend, pull and lift and carry items weighing pounds or less as well as to do simple grasping occasionally.

The position requires manual deviation, repetition and dexterity. Visual requirements include computers and books exposure.

EOE AA M / F / V / Disability

If job posting references any sign-on bonus internal applicants and applicants employed with Telecare in the previous months would not be eligible.