Brightwell Behavioral Health is a Joint Commission–accredited acute inpatient psychiatric hospital located in Garden City, Michigan, and dedicated to serving Michigan’s adult population. We place a strong emphasis on patient-centered care, providing 24/7 referral and clinical liaison services, seamless admissions, and holistic treatment environments designed for safety and dignity.

If you are interested in joining an amazing group of people who are passionate about helping others during their inpatient psych journey, please keep reading!

POSITION SUMMARY:

Responsible for ensuring claims are compliant with all payer specifications; State, Federal and HIPAA regulations and following up on A/R and for the verification of patient’s information, including insurance information, demographic information, etc. Responsibilities also include routing proper paperwork to the billing department and data entry.

REPORTS TO: Revenue Cycle Supervisor

QUALIFICATIONS:

• High school Diploma or equivalent required
• CPC, CCS or RHIT Certification preferred
• Minimum of one to three years experience in handling billing, account receivables and registration/verification in healthcare or related field.
• Strong working knowledge of medical terminology and third-party operating procedures and billing practices.
• Working knowledge of EMR/Billing systems

REQUIREMENTS FOR POSITION:

• Ability to multitask and work independently and under pressure.
• Understanding of community-based organizations/CMH.
• Knowledge of CPT and ICD9 codes.
• Strong verbal and written communication skills
• Ability to operate a computer, including Billing based programs, and general office equipment, including fax machine, scanner, and copier.
• Ability to work proficiently and efficiently in a timely manner.

• Hearing: Hearing acuity sufficient to perform job functions.
• Speaking: Able to articulate goals and objectives of the hospital.
• Vision: Normal visual acuity
• Other: Organizational skills; writing skills; basic computer skills

DUTIES AND RESPONSIBILITIES:

The duties set forth below describe the general nature and level of work being performed by persons assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

• Analyze assignment of all CPT-4, ICD-9, UB04, HCFA 1500 and charges for accuracy and to maximize reimbursement from third party payers
• Analyze insurance payer denials for appropriate response to ensure claim reimbursement and possible appeals
• Critically analyze and process documents for resolution of third-party liabilities, outstanding credits, and un-billed accounts to resolve accounts receivable
• Ensure that all appropriate financial adjustments are posted accurately and in accordance with contracted payment rates, third party billing requirements
• Stay current with knowledge of payer and regulatory changes
• Ensure that billing is submitted accurately, timely, and within the necessary metrics associated with the role
• Evaluate and investigate appropriate actions to be taken to resolve outstanding receivables, in accordance with department goals. Utilize various resources such as third-party publications, procedure manuals and participating contractual agreements, etc.
• Evaluate and validate correct payments received from third party payers
• Make all necessary posting, adjustments and refunds to accounts and critique contractual allowances and other arrangements.
• Research claim payment and claim follow-up, resolving third party rejections using the payer and billing system Insight
• Resolve and collect hospital claims with commercial and government insurance carriers
• Submit billing data to insurance providers thru insurance portals and submit third party claim forms (i.e. UB04 or 1500) through the claims editing software. Understands the claim editing process and resolving the edits based on appropriate department procedures regarding claim submission.
• Track and resolve discrepancies, based on partial payment and contracts.
• Work independently and collaborate in a team environment
• Call insurance payers to status outstanding accounts and obtaining timely resolution
• Mail patient statements and work with patients to set up payment plans if necessary
• Work with Collection agency to provide any back up information for accounts that are in legal status with the collection agency.
• Obtain/verify demographic and insurance information from patients (and/or guardians).
• Explain insurance benefits with patients.
• Deliver the 1st important message from Medicare to all Medicare beneficiaries within 48 hours of admission.
• Attends meetings as required and participate in staff development offerings whenever possible to enhance job performance.
• Follows Dress Code rules and serves as a role model for patients and orientees.
• Follows Center expectations regarding Time and Attendance.
• Performs other duties in a willing manner or as requested by the CEO or Medical Director, including assisting professional and management staff, as required.
• Performs other related duties as assigned