OneMain Financial Jobs

This job was posted by https://www.azjobconnection.gov : For more information, please see: https://www.azjobconnection.gov/jobs/7395080

Overview

This position is located in Benson Arizona. CCSN will be considering Arizona based candidates at this time.

Caring Connections for Special Needs(CCSN) improves the behavioral health and wellness of children through a family support approach. We are founded on the belief that we must focus on our children and families and follow ourCORE FOCUSto improve the lives of children and families. What makes our services unique is the fact that we offer our enrolled members tools and techniques to benefit the daily life of both the children and families we serve.

CCSN is adaptable to child/family needs and looks to provide family support services such as parenting education, assistance in finding employment, and time management to meet the essential needs of the family. We strive to build trust and develop positive relationships with our members and families.

Responsibilities of the Position

The Behavioral Health Claims Billing and Denial Specialist reports directly to the Billing Manager and is responsible for investigating, correcting, and resolving denied claims related to outpatient mental health, community-based behavioral health services, case management, and rehabilitative services. While the primary focus of this role is managing denials to ensure accurate reimbursement and compliance with Medicaid, managed care organizations (MCOs), Medicare, and commercial insurance payer requirements, the specialist is expected to perform any duties within the billing department assigned by the Billing Manager. This position works closely with clinical, authorization, and billing teams to reduce denial trends, improve revenue cycle performance, and support the overall needs of the billing department as directed.

Responsibilities of the Claims and Denial Specialist include but are not limited to the following:

Denial Review and Resolution

• Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) for denied or underpaid behavioral health claims.
• Identify root causes of denials including authorization issues, medical necessity determinations, documentation deficiencies, credentialing discrepancies, timely filing limits, and incorrect modifiers.
• Correct and resubmit claims as appropriate.
• Prepare and submit formal appeals within payer timeframes.

Appeals

• Draft appeal letters addressing medical necessity denials using clinical documentation.
• Collaborate with licensed clinicians to obtain treatment plans, assessments, and progress notes.
• Ensure documentation supports billed CPT and HCPCS codes.
• Track appeal deadlines and outcomes.

Authorization and Eligibility Coordination

• When required, verify prior authorizations for therapy, intensive outpatient services, community-based services, and skills training.
• Ensure units are billed aligned with authorized units.
• Identify patterns related to authorization lapses or eligibility errors.

Revenue Cycle Improvement

• Maintain denial tracking logs by payer, provider, service type, and CPT/HCPCS code.
• Provide monthly denial trend analysis to leadership.
• Recommend corrective action plans to reduce recurring denial categories.

Compliance and Regulatory Standards

• Ensure compliance with HIPAA, Medicaid regulations, and payer-specific billing policies.
• Maintain confidentiality of protected health information (PHI).