Trilogy Behavioral Health

  • Insurance Specialist

    Req No.
    2018-2059
    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 Specialist is responsible for investigating and resolving all billing claim issues (including rejections, denials, etc.).  He/she will review claims and work closely with insurance companies to ensure maximization of reimbursements. 

     

    Essential Responsibilities

    • Investigate, troubleshoot, and resolve insurance claims.
    • Maximize reimbursements through efficient, timely, and comprehensive voucher, delinquent claim, and denial management review.
    • Prepare and file appeals, track outcomes, and comply with all contractual, state, and federal requirements.
    • Act as a client advocate by providing information and education on health insurance benefits, billing, and the reimbursement process to our customers
    • Review and research claims for denial reason. Communicate issues regarding denial trends to Supervisor. 
    • Complete request for reconsideration forms following payor requirements and submit with timely filing periods.  Provide all applicable clinical documentation in accordance with HIPAA standards to ensure maximum reimbursement.
    • Process insurance/client correspondence, and follow-up based on established department policies, procedures, and guidelines.
    • Perform other related duties and/or projects as assigned.

    Qualifications

    • Minimum of 2 years’ experience in healthcare (particularly Medicaid and Managed Medicaid insurance companies)
    • Thorough knowledge of government MCO payers
    • Strong Microsoft Office skills (Word, Excel, Access, etc.)
    • Experience with CareLogic preferred
    • Highly detail oriented with strong organizational skills
    • Strong financial analysis skills, analytical mindset, and intellectual curiosity
    • 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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