Collection Claims Specialist The Raleigh House - 3.2 Denver, CO Job Details $58,000 - $62,000 a year 16 hours ago Benefits Health savings account AD&D insurance Dental insurance Vision insurance 401(k) matching Paid sick time Qualifications Inpatient Insurance verification Mid-level Outpatient Administrative experience High school diploma or GED Medical administrative support Computer networking Contracts 2 years Behavioral health Full Job Description The Raleigh House, a nationally recognized mental health and substance abuse treatment provider has expanded its residential services into the Denver Tech Center. We're seeking motivated and passionate therapists. Ignite your mission and purpose and be a part of an energetic and innovative multidisciplinary team. This role is an exciting opportunity to be a part of an organization focused on clinical excellence that provides an integrative approach with traditional, holistic and experiential therapies. We are seeking a detail-oriented and proactive Collections Claims Specialist to join our dynamic in-house team, with a focus on processing, tracking, and collecting Paid to Patient claims. This position plays a key role in ensuring efficient revenue capture and reducing administrative burdens across clinical operations. By collaborating closely with the Director of Revenue Cycle Operations and other internal departments, you will help optimize our revenue cycle, support compliance efforts, and contribute to the continued growth of our mission-driven organization. Job duties and expectations include, but not limited to: Primary responsibility is the processing, tracking and collection of Paid to Patient claims and monies. Specializing in Carelon, Anthem Elavance, BCBS out of network claims. Joining an exceptional in-house department by partnering with the Director of Revenue Cycle Operations, Utilization Review staff and other professionals to ensure a seamless revenue cycle process. Interface with other departments/clients/families to facilitate client insurance coverage and answer questions Facilitate the refund determination and processing of refunds for insurance patient responsibility amounts Key contact for Client/Family interaction related to insurance/billing questions Support and expand an in house department with the Director of Revenue Cycle Operations that will increase revenue capture and relieve clinical operations of administrative burdens. Foster development of scalable processes. Manage and execute the revenue cycle process, including: billing, coding, claims submission, payment posting, VOB's, and collections. Ensure collaboration across the finance and operations function to produce accurate and timely submission of claims and maximize reimbursement. Create and analyze revenue, KPIs, and reimbursement trends to identify areas for improvement. Develop and implement strategies to optimize revenue, reduce denials, and improve collections. Provide regular reports and analysis to leadership. Ensure compliance with all applicable regulations, including HIPAA, CMS, and payor guidelines in all processes. Maintain and update current and accurate changes in billing and reimbursement rules and regulations. Evaluate and help implement new revenue cycle management software with a cross functional project team. Participate in all meetings and committees related to revenue cycle operations. Provide excellent customer service to patients, payors, fellow employees, and other stakeholders. Resolve billing-related inquiries and address any concerns or issues. Maintain high ethical standards and professional acumen at all times. Treat all HIPAA and sensitive information as confidential. Position specific experience and requirements : Insurance verification of benefits with knowledge of behavioral health preferred Proficiency with institutional claim adjudication with excellent documentation skills Experience with complex claim adjudication, administrative appeals, and medical record requests Experience with out of network claims life cycle Mastery of payment posting, paper and electronic ERA files, ANSI/adjustment coding Experience with modern EMR and billing systems, Alleva/CMD preferred Basic knowledge of healthcare contracts, credentialing and enforcement Desire to learn new ways to maximize revenue cycle opportunities Ability and willingness to engage any portion of claims life cycle to bring favorable adjudication Functional knowledge of individual payor portals and common electronic linkages, Availity, Verify Tx, etc. Our ideal candidate will possess the following experience and attributes: Revenue Cycle/Claims experience in Behavioral Health or other healthcare services industry, including experience in inpatient and outpatient settings. Knowledge of commercial insurance and self pay billing including in and out of network. Collaborative approach, willing to partner closely with our utilization review and operations teams to ensure clean claims and audit compliance while working with other teams. Roll-up-your-sleeves attitude, willing to work in both the details and seeing the entire Revenue Cycle 2 years of Claims experience

Benefits:

Health Insurance benefits including HSA options. Employer Paid Life/AD&D. Dental, Vision, and Voluntary Life/AD&D plans offered. Paid Vacation - 60 hours a year! Paid Sick Leave - up to 48 hours a year! 401k Plans Offered with up to 4% match. Work with a deeply committed, mission-driven team

Pay Range:

$58,000 - $62,000