Claims Escalation & Denials Appeals Specialist

Job not on LinkedIn

🔥 5 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $22 - $24 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Northpoint Recovery

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2014

🏥 Healthcare

Healthcare • Mental Health • Addiction Treatment

Northpoint Recovery is a comprehensive addiction treatment center located in Boise, Idaho, offering a range of services for adults and teens struggling with substance use disorders and co-occurring mental health issues. They provide tailored inpatient and outpatient programs that include detox, individual therapy, and evidence-based treatments like cognitive behavioral therapy, all designed to support lasting recovery and relapse prevention. With a focus on compassionate care and a therapeutic environment, Northpoint Recovery aims to help clients build healthier futures and achieve sobriety.

📋 Description

• Perform collections to ensure receipt of medical claims within twenty-eight (28) days • Make outbound telephone calls to insurance companies and utilize payer portals for claims resolution • Coordinate with insurance companies to ensure timely payment for services rendered • Follow billing and collection protocols to ensure accurate and timely reimbursement • Review accounts receivable accounts and identify payer issues affecting payment delays • Contact payers to understand denials and changes needed to receive payment • Prepare appeals when claim denials are payer errors • Document all correspondence with payers in the billing system • Collaborate with Utilization Review for prior authorization and medical necessity documentation • Maintain accurate patient billing and payment records • Provide management reports on outstanding balances and collections activity • Collaborate with the RCM team and other departments • Maintain working knowledge of Northpoint billing and reimbursement requirements by payer • Adhere to company policies, procedures, confidentiality requirements, and HIPAA guidelines • Perform other job-related duties as assigned

🎯 Requirements

• 2+ years of collections, billing reimbursement, payer relations, or medical Accounts Receivable required • Experience in a healthcare or behavioral health system with multiple levels of care preferred • Experience working with commercial medical insurance billing, as well as Medicaid, claims submission, and the technical aspects of billing software • All-in-one practice management, clearing house and billing software required • Proficient in navigating through payer portals • Must be proficient in CPT, HCPCS, and ICD-10 Codes, DSMS and ASAM criteria, data entry for various third party billing and payers, and their reimbursement and denial patterns • Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems required • KIPU or similar EHR/EMR experience preferred • Problem-solving skills to research and resolve discrepancies, denials, appeals, collections • Familiarity with major payer guidelines • Proficiency with Microsoft Office Suite • Strong organizational skills, multitasking, prioritization, attention to detail, accuracy, and ability to work independently and within a team environment • Ability to maintain confidentiality in accordance with established policies, procedures, HIPAA, and standards of care

🏖️ Benefits

• Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s) • 100% Employer Paid Basic Life Insurance equal to 1x annual salary, up to $100,000 • 100% Employer Paid Employee Assistance Program • Voluntary Dental, Vision, Short-Term Disability, Supplemental Life & AD&D, Critical Illness, Accident, and Hospital Indemnity Insurance. • Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses • Generous Paid Time Off plan • Employee Referral Bonuses • 401K Retirement Plan & Employer Match

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