Trilogy Behavioral Health

Insurance Follow Up Representative

Req No.
2017-1942
Type
Regular Full-Time
Department
Billing

Overview

About Trilogy Behavioral Healthcare:

                                                   
Trilogy Behavioral Healthcare Inc. strongly believes that treatment services are more effective when provided in the client’s natural setting, hence, the majority of services provided are located in the community.  Trilogy Behavioral Healthcare Inc. also employs a holistic approach to each client’s treatment and integrates all facets of our clients’ lives including mental/emotional health, physical health/wellness, employment and education, social and family relationships, substance use/abuse issues, and housing needs.

 

Typical services provided include case management, counseling/therapy, individual skills training, medication training, crisis intervention, linkage to community resources, advocacy, assessment, and treatment planning.

Responsibilities

The Insurance Follow Up Representatitve is repsonsible for investigating and resolving all billing claim issues (including rejections, denials, etc.)

 

Responsibilities

  • Responsible for investigating and resolving insurance claims
  • Maximizes reimbursements through efficient, timely and comprehensive voucher, delinquent claim and denial management review
  • Prepares appeals and tracks outcomes. Complies with all contractual, state and federal requirements
  • Troubleshoots case issues and manages resolution to completion
  • Acts as a client advocate by providing information and education on health insurance benefits, billing, and the reimbursement process to our customers
  • Reviews and researches claims for denials reason
  • Prepares and files appeals timely
  • Completes request for reconsideration forms following payor requirements and submits with timely filing periods. Includes all applicable clinical documentation in accordance with HIPAA Privacy Standards and to ensure maximum reimbursement
  • Follows established Client Accounts appeal guidelines.  Processes insurance/client correspondence, VOC, and ticklers follow-up based on established Trilogy Follow Up unit policies and procedures
  • Communicates issues regarding denial trends to supervisor
  • Provides exemplary customer service; treats clients and coworkers with courtesy and discretion
  • Presents self professionally in all communication with payors
  • Perform other duties as assigned

Qualifications

  • Minimum of 2 years experience in healthcare industry (particularly Medicaid and Managed Medicaid insurance companies)
  • Thorough knowledge of Government MCO payers
  • Strong Microsoft Office skillls (Word, Excel, Access, etc.)
  • Experience with CareLogic peferred
  • Highly detail oriented, with strong organizational skills
  • Strong financial analysus skills, analytical mindeset, intellectual curiousity
  • Ability to investigate problems and develop/communicate solutions
  • Ability to meet assigned deadlines
  • Excellent communication and interpersonal skills with a focus on customer service
  • Ability to act and operate independently, with minimal supervision

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