What are the responsibilities and job description for the Claims Adjudicator position at Community Support Services Inc?
About Us: For 35 years, Community Support Services has been making a difference in the lives of countless individuals with severe and persistent mental illnesses. Our nearly 300 employees are real-life champions committed to quality treatment, collaborative care, and effective outcomes. Located in downtown Akron, Ohio, we serve as a leader in behavioral health care for the entire Summit County area.
The Opportunity: We are seeking to hire a Claims Adjudicator to join our Finance Team. This individual is responsible for claims adjudication for Behavioral Health, SUD, and FQHC claims and processes.
What You’ll Do:
- Manage and resolve claim denials received from Payers within the Billing Guidelines.
- Manage unpaid and/or unprocessed claims within Payer’s time frame, and correct claim(s) according to the Payers’ Billing Guidelines for reprocessing.
- Verify and update inaccurate insurance and/or client information for reprocessing of claim(s). Contact Payers as needed for discrepancies and/or disputes, and update Credible Software.
- Submit FQHC claims for additional wrap around payments on the PNM Portal.
- Manage Charge Tickets for FQHC prebilling.
- Review various reports and file appeals and/or corrections as necessary.
- Complete special reports/projects as assigned by A/R Manager.
- Download 835’s from Etactics Clearinghouse, place in correct Payer folder, enter and maintain in the ERA Spreadsheet.
- This position is full-time (40 hours a week) working normal business hours.
What We’re Looking For:
- Certification and/or training in medical billing.
- Minimum two and a half years medical billing experience.
- Knowledge of CPT and ICD 10.
- Knowledge of medical terminology, medical billing, and Excel and other common medical practice software.
- A deeply held belief in CSS’s recovery-centered mission.
- Ability to communicate in-person and over the phone with clients who have severe and persistent mental illness.
- Ability to multi-task efficiently and effectively.
- Excellent organizational, attention to detail and communication skills.
- Proficiency in Microsoft Outlook.
- Skill in managing time and meeting deadlines.
What We Offer:
- Pay for this position starts at $20-24/hour
- Working within in a mission-driven, highly engaged environment
- A supportive, professional workplace with excellent resources
- Engaging, autonomous atmosphere
- Professional Development Assistance and Education Assistance Program
- Program-Site Eligibility for the Public Student Loan Forgiveness Program
- 401(k) with 5% employer contribution
- 10 paid holidays and 15 days of PTO annually
- Health, Dental, and Vision insurance
- Subsidized membership to local YMCA branches
- Life insurance and short- and long-term disability
Company's website: www.cssbh.org
Company's Facebook page: https://www.facebook.com/103601489691547/
Community Support Services is an Equal Opportunity, Affirmative Action employer: EEO/M/F/Vet/Disability, with an active interest in Diversity and Inclusion.
Salary : $20 - $24
