What are the responsibilities and job description for the REIMBURSMENT SPECIALIST position at Middle Peninsula Northern Neck Community Services Board Inc?
About MPNN BH
At Middle Peninsula Northern Neck Behavioral Health (MPNN BH)
Our purpose is to serve our catchment area with the power of human connection in a compassionate and respectful way. If interested in serving your community while working at a rewarding career, you belong here.
The position of Reimbursement Specialist is responsible for:
- Performs billing functions and follow up for the majority of agency reimbursement including Medicaid, Medicare, Commercial Insurance, Third Party Non-Insurance Payers and Client Self-Pay billing as assigned in order to maximize collections, develops and implements follow-up plans, reporting that information immediate supervisor.
- Directs/advises clinical staff and supervisor in maximizing reimbursement to increase revenues in assigned fund source area.
- Assists in reviewing monthly billings for assigned fund source area and runs monthly reports to assure completeness and accuracy; directs the investigation of discrepancies and denials; and re-bills for services as necessary to receive reimbursement; bills assigned fund sources in a timely manner.
- Verifies insurance coverage, researches insurance information, co-payments, and deductibles, obtains pre-authorizations as necessary; relays applicable information to clinical staff.
- Remains in contact with third party payer representatives as a liaison between clinical staff for assigned fund source area and updates compliance requirements for reimbursement of funds and advises supervisor of requirement changes; keeps up to date files on requirements for assigned fund source area; maintains third party informational grid; acts as resource for information as required by clinical staff; provides training in documentation of services as required for provider.
- Initiates process and assists staff in obtaining and completing provider paperwork required by third party payers for reimbursement of services provided; assist in monitoring status of application until completion.
- Assists with client delinquent account procedures.
- Monitors financial assessment, screens for accuracy; requests missing information from clinics as needed; adjusts accounts based on assessment after information is received; reports in writing system errors or problems.
- Performs Utilization Reviews to insure that proper documentation supports each billing for each Mental Health Clinic, ID/DD Services, Psychosocial Rehab Unit, and In-Home services to include Medicaid SPO and Waiver services; works with staff to set up, monitors to improve billing procedures, and decrease errors; tracks client Medicaid usage within programs to ensure that state limitations to treatment are not exceeded.
- Answers telephone and assists clients with information requests or complaints; researches and resolves client problems or refers clients to other personnel as needed.
- Posts payments received; runs balancing and system of entry audit reports.
- Maintains various files, records, and databases; ensures accuracy and correctness of client personal information.
- Performs routine clerical support for department including filing, mailing, reviewing and preparing correspondence, and answering the telephone on an as needed basis.
- Performs other related work as required.
