Claim Management Team Lead

About the Role

Mindpath Health exists to increase access to mental health care that helps people thrive. We do this by empowering our clinicians, investing in our people, and caring for the communities we serve.

The Claim Management Team Lead is responsible for assisting with all functions associated with all policies and procedures for aged receivables, billing, and third-party payers. The position will also coordinate efficiencies and maintain revenue integrity related to the revenue cycle duties performed by the Claim Management team members. Will help provide customer service that meets and exceeds internal and external customer expectations. Must be an effective communicator who can express themselves daily in a professional manner both verbally and in writing, as well as a proactive professional who can identify trends and solve them promptly. This position reports to the Manager of RCM and will work closely with the RCM Leadership Team and staff.

Responsibilities

• Responsible for leading the day-to-day operations of the claims management team by leading and training team members via Microsoft Teams video training.
• This position collects outstanding receivables from insurance companies, patients, and physicians.
• Provide excellent customer service to patients, providers, leadership, other departments, and other customers.
• Work in a high-volume medical coding and collections environment while maintaining exceptional standards of excellence.
• Strategic in working with insurance companies, healthcare providers, and patients to get a claim processed and paid on time.
• Ensure that the billing and collecting functions proceed in a timely productive fashion.
• Maximize collections efforts to enhance the overall Accounts Receivable performance.
• Follow through on rejected or denied claims by contacting third-party payers and patients for a timely payment resolution.
• Ability to accurately review and bill all secondary and tertiary insurances to correct charges, bill forms, and supporting documentation (EOBs).
• Appropriately identify rejected, denied, or underpaid claims, and work to ensure that trends are identified and resolved quickly.
• Assists in training staff and assists in writing and updating current workflow processes and SOPs.
• Maintain daily billing queues by working and reporting claim edits or following up on claim issues.
• Perform daily financial transactions which include computing, posting, verifying, and recording accounts receivable data as well as prepare, process, and resolve adjustments and payment discrepancies.
• Assist in providing feedback on aging report trends, critical accounts, and workflow status to management.
• Must be able to recognize and apply priorities to internal and external customers.
• Work independently while maintaining confidentiality and following HIPAA regulations.
• Manages daily workflow in a production environment and utilizes all available resources to complete daily work assignments on a timely basis.
• Maintains work operations by following policies, procedures, and reporting compliance issues.
• Updates job knowledge by participating in educational opportunities, reading professional publications, keeping current on Medicaid/Medicare billing, and reimbursement procedures
• Supports a teamwork environment and participates in required virtual meetings (via Teams or Zoom) and continuing education sessions as required.

Qualifications

• High school diploma or equivalent; college degree or certification preferred 
• 5 years of progressive experience in medical coding, billing, and collections
• Previous experience in mental/behavioral health and at-risk payers is a plus
• Proficiency with Microsoft Office (Outlook, Excel, and Word) 
• Knowledge of insurance payer requirements as it relates to benefit coverage, referrals, and authorizations
• Knowledge of processes and methods for maintaining clear and precise notes received from insurance payers related to insurance verification communication with payers
• Knowledge of insurance billing and collection guidelines including HMO/PPO, Medicare, Medicaid, other third-party payers, HCPC, CPT, ICD-10, coding and medical terminology, LCDs (Local Coverage Determinations), payer billing guidelines and medical policies
• Knowledge working in online payer portals such as: Availity, NaviNet, Orthonet, Humana, UHC, Cigna, etc.
• Detail-oriented self-starter with a strong work ethic
• Highly professional, confident conscientious and cooperative attitude
• Strong written, verbal communication and organizational skills, as well as excellent customer service skills
• Knowledge and understanding of legislation and regulations regarding healthcare practices and CMS regulations
• Ability to multi-task and meet deadlines as well as be proactive, self-directing and take initiative
• Ability to collaborate effectively with medical staff, revenue cycle team and external agencies
• Ability to prioritize tasks and initiatives while managing multiple projects

The Benefits
We offer a robust benefits package to include:

• Medical, Dental, Vision, and EAP
• LTD/Life Insurance
• 401k with employer match
• PTO accrual starting at 15 days per year
• Paid Parental Leave
• Tuition Reimbursement Program

About Mindpath Health

Mindpath Health exists to increase access to mental health care that helps people thrive. We do this by empowering our clinicians, investing in our people, and caring for the communities we serve. As a national leader in mental health services, we are reimagining care delivery, reaching patients and focus on clinical excellence. With a team of more than 500 mental health clinicians, Mindpath Health provides a broad spectrum of psychiatry, interventional psychiatry (including TMS and esketamine) and psychotherapy care.

At Mindpath Health, we offer telehealth and in-person visits and coordinate care with primary care physicians and referring providers to ensure a focus on the total health. Mindpath Health is in-network with most major health insurance providers and has more than 80 locations across California, North Carolina, South Carolina, Florida, Texas, Arizona, and growing.

Join our community and discover how rewarding work can be!

Mindpath Health is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, ancestry, age, disability, veteran status, or any other status legally protected by federal, state, or local law.

Salary : $20 - $22