A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
Behavioral Health Billing & Prior Authorization Specialist Stepping Stones To Success Behavioral Health Toledo, OH Job Details Part-time $20 - $24 an hour 14 hours ago Qualifications Customer communication Customer service HIPAA Medical administrative support Attention to detail Medical terminology Full Job Description Job Summary Stepping Stones to Success Behavioral Health is seeking an experienced Behavioral Health Billing & Prior Authorization Specialist to assist with Medicaid managed-care billing, prior authorizations, claim follow-up, and insurance requirements. We are looking for someone who can independently manage the billing and authorization process and help ensure services are properly authorized, submitted, tracked, and followed through to payment.
Preferred experience:
Previous behavioral health or mental health billing experience; knowledge of Ohio Medicaid and managed-care organizations; experience with prior authorizations, claim denials, HCPCS codes, units, and medical-necessity documentation; and familiarity with EHR/clearinghouse systems. This position is ideal for someone who is organized, persistent, detail-oriented, and comfortable contacting insurance companies and independently researching billing issues. Behavioral health billing experience is required. Experience with Ohio Medicaid Managed Care plans, including Buckeye, CareSource, Anthem, Aetna, Molina and/or Humana, is strongly preferred. Candidates should have hands-on experience with prior authorizations, claim denials, medical-record requests, claim reconsiderations, and payer follow-up. This is not an entry-level billing position. The ideal candidate should be comfortable independently researching and resolving billing and authorization issues with minimal supervision.
Responsibilities include:
Complete and submit behavioral health prior authorization requests Track authorization limits, expiration dates, approved units/visits, and renewals Submit and follow up on Medicaid/MCO claims Research denied, rejected, pending, and medical-record-review claims Correct and resubmit claims when appropriate Submit supporting clinical documentation and medical records when requested Follow up directly with insurance companies regarding outstanding claims and authorizations Maintain organized tracking of claims, PAs, denials, and payer correspondence Work with clinical staff when additional documentation is required Assist with CareSource, Buckeye, Anthem, Aetna, and other Ohio Medicaid managed-care plans Review and verify insurance coverage for behavioral health services, including managed care plans and health insurance policies. Obtain and process insurance prior authorizations by collaborating with healthcare providers, insurance companies, and patients to ensure timely approvals. Accurately code clinical documentation using CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems to ensure proper billing. Prepare and submit medical claims using Electronic Health Records (EHR) systems while adhering to HIPAA privacy regulations and clinical confidentiality policies. Follow up on unpaid or denied claims, resolving discrepancies through effective communication with insurance companies and patients. Maintain detailed medical records and ensure compliance with all healthcare documentation standards. Provide excellent customer service by addressing patient inquiries related to billing, insurance verification, and authorization status. Skills Strong knowledge of HIPAA regulations, medical terminology, and clinical confidentiality policies. Proficiency in CPT coding, ICD-9/ICD-10 coding systems, and medical billing procedures. Experience with Electronic Health Records (EHR) or Electronic Medical Records (EMR) management systems. Familiarity with health insurance policies, managed care processes, and insurance verification procedures. Excellent communication skills for interacting effectively with patients, providers, and insurance representatives. Ability to navigate Microsoft Office applications efficiently for documentation and reporting purposes. Knowledge of healthcare industry standards related to medical records management and clinical documentation. Join our team as a Behavioral Health Billing & Prior Authorization Specialist if you are passionate about supporting mental health services through meticulous administrative work! Your expertise will directly impact the efficiency of our operations while helping patients access the care they need in a compliant and respectful manner. We welcome motivated professionals eager to grow within a supportive environment dedicated to excellence in behavioral health services.
Pay:
$20.00 - $24.00 per hour Expected hours: 20.0 per week
