Administrative Assistant V - Insurance Follow-Up

This position supports the Fiscal Team and plays a vital role as part of the Revenue Management Team, which manages billing, collections, tracking, and reporting for approximately $30 million in client and third-party fee revenues. Assists with denial management process by identifying issues, conducting follow-ups, and reporting findings to the supervisors. Generates detailed denial reports to support revenue enhancement efforts and provides regular updates to the FSIII regarding denied claims across various categories.

Under the supervision of the FSIII, this position is responsible for third party reimbursement functions. Monitors revenue cycle activities to analyze denial data and to resolve any issues. Works directly with insurance payers to find denials reasons, identifies trends and works collaboratively with all stakeholders to resolve denial matters. Superior knowledge of timely filing for each payer and ability to be able to tackle the issue as well as prioritization skills are essential. Coordinates no authorization denials in collaboration with the Utilization Management Team (UMT) to obtain necessary updates Independently and proactively runs status reports on claims requiring authorization and works with UMT staff for resolution. Conducts research for denials related to ineligible providers and collaborates with Contracts and Credentialing staff for resolution. Leads communication with department contacts regarding accounting errors, billing issues as well as modifications. Responsible for keeping timely overpayment correspondence to ensure compliance with the policies. Represents the agency with regards to VARO group inquiries and takes the lead to research/track/monitor responses and notifies RMT staff with updates.

Coordinates no authorization denials in collaboration with the Utilization Management Team (UMT) to obtain necessary updates. Independently and proactively runs status reports on claims requiring authorization and works with UMT staff for resolution. Conducts research for denials related to ineligible providers and collaborates with Contracts and Credentialing staff for resolution. Periodically plans actions to adjusts not recoverable claims and makes recommendations to reduce the denials to enhance fee revenue. Directs the process of generating automated payment reports, audits, and reconciles payments to both manual and system generated documents to ensure accuracy in payment posting. Responsible for follow-ups on daily post processing activity including but not limited to re-issuance of denied claims statements. Collaborates with insurance companies to resolve pending issues and shares findings with their supervisor. Leads communication with department contacts regarding accounting errors, billing issues as well as modifications. Responsible for keeping timely overpayment correspondence to ensure compliance with the policies. Demonstrates appropriate levels of knowledge with regards to ICD-10, CPT and/or HCPCS coding systems as well as claims forms CMS-1500 and UB-04. Receives and evaluates billing requirements from clearinghouse vendor, implements changes, and disseminates relevant information. Demonstrates initiative and knowledge to research, understand, and resolve complex financial issues. Ability to handle confidential and sensitive information.

Works under the general supervision of Financial Specialist III (FSIII).

Functional areas: Finance

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MINIMUM QUALIFICATIONS:
Any combination of education, experience and training equivalent to high school graduation and four years of experience providing administrative support in the assigned functional area(s).

NECESSARY SPECIAL REQUIREMENTS:
The appointee to this position will be required to complete a criminal background check, a Child Protective Services Registry check, and sanction screening to the satisfaction of the employer. A TB screening upon hire.

PREFERRED QUALIFICATIONS:

• Experience with and knowledge of ICD-10, CPT and/or HCPCS coding systems as well as claims forms CMS-1500 and UB-04
• Experience working in accounts receivable and with Aged Trial Balance reports.
• Experience working with reimbursement billing.
• At least four years of experience of mental health billing.
• At least four years of mental health follow-up services experience with excellent customer service skills with the ability to interact in a friendly, service-oriented, and professional manner with insurance payers and client.
• Experience utilizing electronic health records.
• Supervisory experience.
• Experience with gathering and analyzing data and to generate reports.
• Ability to efficiently prioritize workload and adhere to deadlines.
• Ability to work independently and in a team environment, be proactive, exercise good judgment, and use critical thinking skills
• Possess an intermediate level of expertise in Microsoft Excel, Outlook, Word, and PowerPoint and can demonstrate it through practical exercises