Claims Escalation & Denials Appeals Specialist

Claims Escalation & Denials Appeals Specialist

Meridian,

Job Title: Claims Escalation & Denials Appeals Specialist

Reports To: Billing & Collections Supervisor

Location: Home Office in Meridian,

Schedule: Monday-Friday 8am-4:30pm

Job Type: Hybrid with Rotating Schedule - In office 1 week & Work from home 1 week

Compensation: $21-24/hour

Northpoint Recovery Holdings, LLC began 2009 as Ashwood Outpatient and officially launched the Northpoint platform in 2015. Northpoint is a leading behavioral healthcare provider offering evidence-based treatment for adults with substance use and co-occurring disorders through the Northpoint Recovery brand, and mental health treatment for adolescents through Imagine by Northpoint. Operating under an in-network, commercial insurance model, Northpoint has grown exclusively through de novo expansion—from two facilities to seventeen across the Western U.S.—with more planned in both existing and new markets.

We’re guided by core values of humility, heart, inspiration, and conviction. Our mission is simple: saving lives and restoring relationships by helping people get their lives back, and treating every individual with empathy and respect.

POSITION SUMMARY: As a key member of the Revenue Cycle Management team, the Claims Escalation & Denials Appeals Specialist is responsible for the ongoing collection, denial management, and accounts receivable of assigned accounts. This role involves working closely with patients, insurance companies, and Northpoint providers to ensure that all payments are collected in a timely manner, and payer denials/rejections are worked and followed up on to exhaustion, or payment of services.

The ideal candidate will have a solid understanding of the entire billing life cycle of a patient, to include verifications, pre-authorization, utilization review, appeals, claims submission, claims adjudication, and denials. The ideal candidate will have strong knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems required.

ESSENTIAL

RESPONSIBILITIES AND DUTIES:

• 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 existing billing and collection protocols to ensure accurate and timely reimbursement
• Review accounts receivable accounts to ensure accurate reimbursement and identify payer issues affecting payment delays
• Contact payers to get a clear understanding of denials and changes needed to receive payment
• Prepare appeals, when necessary, when claim denials are payer errors
• Document all correspondence with payers in the billing system
• Collaborate and coordinate with Utilization Review for prior authorization/medical necessity documentation
• Knowledge of CMS and Third-party payer regulations and guidelines
• Thorough understanding of Explanation of Benefits
• Maintain accurate records of patient billing and payment information
• Provide reports to management on outstanding balances and collections activity
• Provide excellent communication and customer service skills
• Utilize a strong understanding of insurance billing and coding requirements
• Maintain active working knowledge of Northpoint billing and reimbursement requirements by payer
• Collaborate with RCM team and other departments to ensure successful execution of assigned duties and priorities
• Maintain confidentiality in accordance with established policies and procedures and standards of care
• Adhere to all Company policies and procedures
• Perform other job-related duties as assigned

QUALIFICATIONS/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…