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Nevada Behavioral Health Solutions is currently seeking a Medical Claims Specialist in the Las Vegas area!
Welcome to Nevada Behavioral Health Systems
Since 2015, Nevada Behavioral Health Systems has managed the mental health and substance abuse services for residents of Nevada. We have created a network of providers who focus on the core principles of recovery: strengths-based, person-centered, individualized treatment and support for people with mental illness and substance use disorders.
What We Do
NBH has developed a comprehensive, community-based system of care by contracting with experienced providers offering evidence-based services. We contract with a wide variety of behavioral health care providers to respect and ensure member choice and to meet the special health care needs of our members.
Job Responsibilites and Duties (not limited too):
- Review, evaluate, and thoroughly investigate claims to determine contractual coverage.
- Eliminate non-behavioral claims outside of the contracted financial responsibility.
- Investigate, evaluate, and identify medical claims, applying technical knowledge and compliance & contract relations skills to affect provider cases’ validity and contribute to a reduced contractual non-behavioral financial responsibility ratio.
- Gather data from different sources to create or recreate a report and analysis. It involves communicating with internal and external personnel.
- Refer questionable claims to the supervisor for further investigation.
- Maintain files, such as a master list of contracted provider records, rate sheets, and a top list of claims requiring detailed analysis.
- Prepare and maintain a status report of findings weekly and monthly for review and submittal.
- Prepare and maintain a summary report needed for monthly KPI reporting.
- Other duties as assigned.
Skills:
- Advance excel skills
- Strong critical and analytical thinking skills
- Ability to follow procedures
Preferred but not Required:
- Knowledge of medical and behavioral codes, medical claims, claims processes, and procedures.
Benefits:
- Medical (PPO Option available)
- Dental
- 401(k) w/ match
- Paid Time Off
- Paid Major Holidays
Nevada Behavioral Health Systems is proud to be an Equal Opportunty Employer!
Job Type: Full-time
Pay: $45,000.00 – $55,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
Schedule:
- 8 hour shift
Work Location: In person
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