Behavioral Health Claims Analyst

Company Overview: Full Circle Health Network is an integrated network of nonprofit, nationally accredited providers delivering coordinated, community-based services to vulnerable children, individuals and families across California. Full Circle exists to ensure more Californians can access culturally congruent and trauma-informed care from a high-quality network of community-based organizations that address their whole-person and whole-family needs. We accomplish this primarily through the following core activities: ·        Serve as a single contracting vehicle for community-based providers to enroll in Medi-Cal managed care plan networks. ·        Reduce administrative burden for providers so they can focus on serving clients.

·        Drive improved coordination between providers across multiple systems through technology infrastructure, training, and administrative practice support. The Full Circle Health Network embraces the population health vision of CalAIM. Healing trauma, stabilizing home environments, and reuniting families promotes wellness throughout a child’s lifetime reaping innumerable future individual and societal benefits.   Full Circle Health Network is closely affiliated with the CA Alliance of Child and Family Services, under the governance of the California Alliance Board of Directors. The Network has an advisory board made up of subject matter experts and participants of the network. JOB DESCRIPTION:

Full Circle Health Network is seeking a highly organized and detail-oriented Claims/Billing Specialist to join our team. This role will involve managing and processing claims, ensuring billing accuracy, and working collaboratively with providers, health plans, and internal departments. The Claims Analyst will need to work with a combination of data analysis, billing, and claims management to address issues of claim denials, reimbursement delays, and eligibility verification. The position requires a good understanding of the guidelines from organizations like DHCS, DMHC and Health Plans, along with strong analytical, and problem-solving skills. This role will report into the Claims Manager.

Knowledge/Skills/Abilities·        Strong math, typing, and computer skills·        High level of accuracy, efficiency, and accountability. ·        Excellent communication, research, problem – solving, and time management skills·        Ability to build relationships with providers, health plans and internal departments·        Proficiency with Microsoft Office Suite, particularly Excel. ·        Ability to multitask and prioritize ·        Ability to make informed decisions on claim/billing approvals, denials, and provider disputes. ·        Ability to create, maintain detailed claim/billing records, generating reports on claim/billing trends, along with adhering to performance metrics. ·        Competency in reading, interpreting and documenting Health Plan contracts, Provider contracts, State and Federal regulatory guidelines.

·        Aptitude in managing own time, priorities, and resources to achieve individual, department and company goals. Required Education Bachelor's Degree in related field or equivalent experience. Required Experience 3-5 years experience in health or behavioral healthcare billing/claims and/or delegation oversight. Preferred Education Graduate degree or course of studies in, business, or health care managementEXPECTED HOURS: This is a full-time position.  COMPETENCY REQUIREMENTS   Reports To: Manager, Claims Oversight Key Responsibilities: Research, create, and maintain all reimbursement-related information and data to ensure compliance with regulatory and contractual requirements. Analyze claim data to identify patterns, inconsistencies, and opportunities for process improvement.

Ensure accuracy and thoroughness when reviewing claim and billing information to minimize errors and ensure compliance. Identify issues within claims and collaborate with relevant parties to develop and implement effective solutions. Utilize strong communication and interpersonal skills to interact with providers, health plans, vendors, internal staff, and leadership in a professional manner. Expertly navigate and utilize claims/billing systems to ensure proper claims management and tracking. Stay current on claims and billing regulations, industry standards, and best practices to ensure compliance. Adhere to established claim routing and inventory control procedures to ensure accurate processing and tracking.

Generate detailed reports and documents for both internal and external use, ensuring clarity and accuracy. Participate in ongoing educational opportunities to continuously update and enhance job knowledge, ensuring the team remains at the forefront of industry changes.