Claims Analyst

Partners Behavioral Healthcare finds and restores individuals struggling with substance use and mental health disorders. We provide behavioral health services for justice-involved individuals that need to break free from addiction and criminal thinking, manage mental health, and take control of their lives amidst the complexities of the justice system. Partners Behavioral Healthcare provides compassionate, individualized programs and a community invested in helping clients achieve long-term, lasting recovery giving them the opportunity for reconciliation with self and others, hope in a better life, and a purpose to explore and achieve.

The Claims Analyst plays a key role in the administration and management of the company's billing and claim processes to include managing medical billing for clients, updating client information, generating invoices, claim follow-up and processing payments.

• Assist counselors with making corrections service lines and set up Reauthorization requests as needed.
• Notify counselors when a client's insurance when client's hours are depleted.
• Ensure counselors have alerted the billing department about any discharges that need to be completed in DAANES or Procentive.
• Enter all client authorization faxes received throughout the day.
• Verify any changes communicated by the State in MN ITS.
• Verify new or updated service agreements and enter them correctly into Procentive and DAANES.
• Review admission schedules for all locations to ensure that all clients scheduled have payer information entered correctly.
• Daily auditing to find and resolve billing errors.
• Follow-up with insurance companies regarding any denials and make requests for denials to be resubmitted or resolved.
• Communicate with insurance companies regarding benefit coverages.
• Manage receipt of payments via the ERA Module (Electronic Remittance Advice) and reconcile each service line with payment.
• Track and verify every client insurance monthly for any changes or a client has termed or rolled over.

• Enter new payer information in client charts via HP, Availity, UCare, Optum and MN ITS websites.
• Verify all billable services have been entered for the previous week.
• Verify that all billable services submitted have gone through the Clearinghouses, received by the insurance companies, audit for any errors and investigate accordingly.
• Work to set up funding plans and agreements when client insurance problems arise.
• Input all payment information and verify weekly payments.
• Post personal check funds also against any service lines that have been entered correctly.
• Year-end reconciliations.
• Other duties as assigned.

• Effective communication, including writing, speaking and active listening.
• Great customer service skills, including interpersonal conversation, patience, and empathy.
• Good problem-solving and critical thinking skills.
• In-depth knowledge of industry best practices.
• Basic math, bookkeeping and accounting skills.
• Organization, time management and prioritization abilities.
• Ability to maintain the confidentiality of client information.
• Understanding of industry-specific policies, such as Health Information Portability and Accountability Act
• (HIPAA) regulations for health care.
• Effective computer skills to input to use bookkeeping and account management software in a timely and efficient manner.
• Organized and capable of gathering data from multiple sources, many for more than one bill at a time.

• Utilize interpersonal skills to solve problems, answer questions and collaboratively produce mutually beneficial solutions.

• Be at least 18 years of age.
• High school diploma or equivalent.
• 2-3 years of related experience.
• Ability to pass a MN OHS (Department of Human Services) Background Study.

• Associate or bachelor's degree in related field.
• Certifications: CM RS, CPB, CPC
• Experience with Microsoft Office 365 software.
• Knowledge of Procentive software.
• Background in finance and/or accounting.
• Computer literacy including experience using an electronic health records (EHR) system.

CONTINUED EDUCATION AND TRAINING:

• Attend any mandatory staff meetings and trainings.
• Remain up to date with all current PIR policies and procedures.

The above list reflects the general details necessary to describe the principle and essential functions of the position and shall not be construed as the only duties that may be assigned for the position.