Claiming Analyst - Revenue Cycle Management

JOB SUMMARY: Sycamores provides a spectrum of equitable mental health services through various programs to multicultural populations of all acuities. Although it serves a variety of consumers, the agency focuses primarily on providing care to low-income, high at- risk youth.
 

The role of the Claiming Analyst is to maintain electronic claiming functionalities within the Electronic Health Record System (EHRS). The maintenance of the claiming functionalities within the Electronic Health Record System will include but is not limited to working denials, processing voids and claims.

DUTIES AND RESPONSIBILITIES:(These are the essential job functions for this position. The essential functions of this job include but may not be limited to those listed in this job description. Employees hired for this position must be able to perform the essential function of this job without imposing significant risk of substantial harm to the health or safety of themselves or others.)
 

1. Use internal communication to track admissions across all programs, in order to accurately create and open consumers financial profile in both EHRS and IBHIS.  
2. In collaboration with eligibility worker, research and resolve consumer eligibility issues.
3. Responsible for weekly submission of EDI claims to LACDMH, including voids and resubmissions. It is the responsibility of the Analyst to ensure all claims have completed all steps in the Revenue Cycle.
4. In collaboration with Claiming and Revenue Manager, claim, track and monitor invoice/EDI claims to other funding entities to ensure timely submission.
5. Verifies that batches have been submitted properly by performing reconciliation to identify any discrepancies that may have occurred within the batch. 
6. Monitor, analyze, correct and resubmit claims to LACDMH in a prompt and accurate manner.
7. Maintain proficiency in Sycamores EHR system and DMH IBHIS and affiliate systems to process external claims. 
8. Responsible for responding to claiming inquiries, such as progress note corrections, funding issues and program changes.
9. Maintain the highest level of customer service when responding and collaborating with internal and external consumers.
10. Process LACDMH C# applications in order to grant or renew staffs access to DMH forms. 
11. Duties and responsibilities may be added, deleted and/or changed at the discretion of management
12. Performs other related duties as assigned.

 NOTE: The job duties listed are typical examples of the work performed by positions in this job classification. Not all duties assigned to every position are included, nor is it expected that all positions will be assigned to every duty.

Starting Pay Range:

$25.50 - $28.50 per hour per hour (starting pay will be based on previous work experience and educational background.)

JOB QUALIFICATIONS

• High school diploma or equivalent; associate or bachelor’s degree preferred.

• Minimum of 1-2 years’ experience in QA/QI related activities or mental/managed care billing preferred.
• Experience in data entry, billing, or administrative work required.
• Familiarity with the LA County IBHIS system is a plus.

Additional Requirements:

•  Basic math skills.
• Ability to accurately enter detailed accounting data on the computer. 
• Intermediate level knowledge of Microsoft Excel and Outlook programs.

All candidates who are presented with a conditional offer of employment must satisfy a pre-employment background check, drug and health screen.

Sycamores is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Further, Sycamores is a Fair Chance employer and complies with California Government Code Section 12952, Employment Discrimination: Conviction History.