Claim Edit Specialist
MINDPATH HEALTH
Houston, Texas
insurance
health
patients
management
mental
mental health
practice management
management system
data
outpatient
excel
customer service
addiction recovery
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November 28, 2022
MINDPATH HEALTH
Houston, Texas
OTHER
About the Role
The Claim Edit Specialist will be responsible for verifying mental health benefits, authorizations, and registration. The coordinator will utilize practice management system to enter insurance and patient demographic data as well as run reports to identify and correct errors. This position requires collaboration with various staff, insurance companies, and patients to resolve insurance issues via the telephone.
Responsibilities:
Responsible for maintaining production metrics as outlined by department manger or director.
Responsible for reviewing and resolving accounts with 97% quality accuracy daily.
Responsible for providing research and root cause analysis for quality completion.
Identify payer or user performance trends and report root cause to manager.
Responsible for analyzing various claim, payer, and clearinghouse edits performing appropriate action of submitting a clean claim with accuracy.
Identifies, documents, and communicates trends and gaps for internal reporting and process improvement.
Update and note actions taken on account.
Utilize phone system, Advanced MD and/or insurance website portals to verify patients’ insurance benefit details.
Obtains registration and authorizations for outpatient mental health visits when needed.
Registers patients using the practice management system (AdvancedMD) once coverage is confirmed
Reference credentialing spreadsheets to verify provider participation and escalate discrepancies
Sets up new cases for existing patients when insurance plan changes, including provider or location transfers.
Contacts patients to address insurance and/or demographic errors.
Capable of navigating payer portals, systems, and excel.
Requirements:
Associate degree preferred, High school diploma or equivalent
Basic proficiency with Microsoft Office (Outlook, Excel, and Word)
Call center experience desired
Excellent data entry/typing skills
Excellent customer service skills with previous customer service experience preferred
Excellent written and verbal communication skills
Strong attention to detail with the ability to prioritize and multi-task
Ability to work well within a team setting and independently (as needed)
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 is committed to providing the highest quality and most comprehensive outpatient behavioral health care to help people navigate life’s challenges, whenever and wherever they need it. Our unique, collaborative care approach and integration of the latest treatments and technologies ensure our patients receive the continuum of care required for optimal outcomes. Our services are delivered at more than 75 locations across the nation and include medication management and individual therapy both in office and via telehealth, addiction recovery services at the Addiction Recovery Center (ARC), group therapy sessions and TMS (transcranial magnetic stimulation) therapy. To help everyone seeking treatment, our 450+ providers participate in most major insurance plans.
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.
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