Insurance Benefits & Eligibility Specialist

Description

The Insurance & Revenue Cycle Specialist plays a pivotal role in ensuring the accurate and efficient management of co-payments, referral authorizations, claims processing, client intake, and revenue cycle operations within Mindfully Behavioral Health. This position requires a strong customer service skill set for internal and external communications. The patient should always come first. Confirms insurance details needed to assess patient eligibility. Responds to and interacts with a variety of individuals including clients, referring providers, other administrative team members, for a majority of every day. The role requires a strong understanding of behavioral health billing practices, collection practices, systems, insurance eligibility and benefits, high level of attention to detail, and compliance with standards to optimize reimbursement and support the financial health of Mindfully Behavioral Health.

Benefits:

• Health, vision, and dental insurance
• Paid time off
• Paid holidays plus floating holiday
• HSA with employer match
• Dependent care FSA
• Employer-paid Life and AD&D insurance
• Employer-paid short-term and long-term disability
• WellWorks wellness program
• Employee assistance program
• 401k with employer match

Primary Responsibilities:

• Key Responsibilities:
  • Insurance:
    1. Effectively understand and communicate Eligibility and Benefits (“E&B”) provided by insurance companies, to various parties, such as patients, providers, and RCM Team.
    2. Run E&B checks with insurance; ensuring credit card is on file for direct payments and client is supported and prepared for their session.
    3. Collect proper documentation for insurance E&B and payment process.
    4. Understand the insurance verification systems and portals.
    5. Aide in the intake process while performing the E&B process.
    6. Assist with answering phones and scheduling patients, as it relates to insurance E&B or Accounts Payable conversations.
    7. Serve as a front office resource to immediately handle questions for improved client experience through insurance E&B and revenue cycle.
    8. Perform batch verifications and follow-ups on the results of the batch.
    9. Communicate the results of the batch verification to achieve desired results.
    10. Understand payer contracts (i.e. insurance agreements) and rate tables.
  • Claims and Insurance E&B Follow-Up and Denial Management:
    1. Monitor the status of submitted claims and actively pursue resolution of pending or denied claims.
    2. Analyze claim denials to identify root causes, address discrepancies, and request that claims be resubmitted.
    3. Collaborate with payers and patients to resolve claim disputes and secure timely reimbursement.
    4. Perform patient outreach on claims to solve issues or establish payment options.
    5. Effectively understand and communicate Eligibility and Benefits (“E&B”) provided by insurance companies, to various parties, such as patients, providers, and RCM Team.
  • Accounts Receivable
    1. Monitor the Accounts Receivable aging reports.
    2. Review patient and insurance situations, looking to solve existing aging issues.
    3. Perform patient and insurance outreach to address aging balances and issues.
  • Payment Posting and Reconciliation:
    1. Accurately post payments, adjustments, and rejections to patient accounts, ensuring proper allocation and reconciliation.
    2. Reconcile payments received with billed amounts and contractual adjustments.
    3. Process refunds and adjustments in accordance with organizational policies.
  • Reporting and Analysis:
    1. Provide insights and recommendations to optimize insurance E&B, and revenue cycle efficiency and effectiveness.
    2. Provide reports and dashboards for decision making opportunities.
  • Compliance and Documentation:
    1. Stay up-to-date with behavioral health insurance E&B, coding guidelines, and payer requirements.
    2. Ensure compliance with HIPAA regulations and other relevant behavioral health and mental health standards.
    3. Maintain accurate and organized documentation related to insurance E&B, claims, and reimbursement activities.
  • Team Collaboration and Training:
    1. Collaborate with clinical and administrative teams to streamline insurance E&B and revenue cycle workflows.
    2. Collaborate with the accounting team to resolve any discrepancies or issues.
• General Responsibilities:
  • Attend and participate in Insurance E&B and Revenue Cycle meetings.
  • Understand and stay up-to-date with insurance and revenue cycle systems and software.
  • Assist with the preparation and maintenance of financial records.
  • Monitor and follow up on outstanding accounts receivable, facilitating timely collections.
  • Assist in the preparation of regular reports and other ad hoc reports as needed.
  • Provide support and guidance on credentialing and payor scenarios.
  • Identify opportunities for process improvements and efficiency enhancements in accounting procedures.
  • Properly advise patients regarding the need for co-payments.
  • Ensure the patient arrives prepared for their session.
  • Confirm insurance details needed to assess patient eligibility.
  • Responds to and interact with a variety of individuals including clients, referring providers, other administrative team members, for a majority of every day.
  • Navigates multiple systems and complex scheduling workflows, phone calls, emails, and fax.
  • Perform other duties as assigned.

Skills / Qualifications:

• 2 - 3+ years relevant experience required
• Experience in healthcare and/or insurance office, specifically benefits and eligibility, revenue cycle management, or billing.
• Basic understanding of financial transactions.
• Medical industry or healthcare related B2B & B2C experience preferred.
• Extraordinary attention to detail, organization and file management skills.
• Superior command of written and spoken English; the ability to write original content.
• Working knowledge of Microsoft Office, especially Excel, and the ability to navigate and retrieve data from business related software.
• Self-starter with exceptional customer service skills - this person brings a track record of handling difficult and emotional. conversations while maintaining positive communication (i.e. payments).
• Coachability – willingness to adapt based on learning and needs.
• Problem solver – Thinks independently; raises blockers and can offer possible solutions.
• Experience and comfort with navigating and working within multiple systems simultaneously, specifically Inbox Health, EMR, Kareo, Verify TX, experience strongly preferred.
• Strong contributor to the culture.

Physical Requirement:

• Prolonged periods of sitting at a desk and working on a computer and phone.

Mindfully Behavior Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and internship. 

Mindfully Behavior Health makes hiring decisions based solely on qualifications, merit, and business needs at the time. Furthermore, the Company will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.