Job Description:

Essential Job Functions:

• Conducts investigations of billing, coding and documentation concerns identified through the Compliance Disclosure Program.

• Analyze and investigate payor refund requests and provide recommendations on response (e.g. submit appeal, issue refund).

• Documents investigation process, maintaining a high-level of detail and composes written reports that include determinations and corrective action.

• Identification and reporting of abnormal billing patterns and other indicators (e.g. services not rendered, up-coding, unbundling, etc.) of suspected fraud and abuse to the Lead Compliance Audit Coordinator.

• Works closely with members of the Revenue Cycle Department to ensure timely repayment of any identified overpayments.

• Presents findings and recommendations in a professional and knowledgeable manner.

• Demonstrates problem solving strategies and recommends corrective action for deficiencies, including assisting with developing recommendations for changes in policies and procedures relevant to compliant billing processes.

• Assist with developing recommendations for changes in policies and procedures relevant to compliant coding and billing.

• Support Compliance Office with other duties as assigned.

Knowledge, Skills, and Abilities:

• Knowledge of Federal and state healthcare reimbursement requirements

• Proficient in ICD-10, CPT and HCPCS coding guidelines

• Ability to prioritize work to meet deadlines consistently in a predetermined schedule.

• Ability and willingness to research and analyze data, draw conclusions, read, interpret and apply policies, procedures, laws and regulations.

• Strong analytical, written and verbal communications skills.

• Organizational skills, self-motivation, and the ability to work independently.

• Ability to work confidentially in a fast-paced, demanding environment.

Experience and Education Qualifications:

• Associates degree in Health Information Management, preferred

• At least one of the following credentials (RHIA, RHIT, CCS, CPC, COC), strongly preferred

• 1 to 3 years of medical billing experience with preferred education.

• 5 years of industry experience, including 1-3 years of medical billing experience without preferred education.

• Prior behavioral health coding or billing experience, preferred.

Supervisory Requirements:

None

Employment Requirements:

• Successful completion of background check including criminal record, driving record and abuse/neglect.

• Completion of New Hire Orientation at the beginning of employment.

• All training requirements including Relias Learning at the beginning of employment and annually thereafter.

• Must have a current driver’s license, acceptable driving record and current auto insurance.

Physical Requirements:

• ADA Consideration - Sedentary work: Exerting up to 10 pounds of force occasionally (exists up the 1/3 of the time) and/or a negligible amount of force frequently (exists 1/3 to 2/3 of the time) to lift, carry, push, or pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.

Preferred Family Healthcare is a Smoke and Tobacco Free Workplace.

About Brightli

Brightli is on a mission: A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance use care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients. We are doing this by forming a new behavioral health organization under new model. Under one parent company, multiple organizations are able to collaborate, share resources and system supports, increase recruiting and retention efforts, increase access to specialized care, and meet the growing demand for behavioral and addiction recovery care.

Brightli’s top-line subsidiaries include Burrell Behavioral Health (Burrell), Preferred Family Healthcare (PFH), and Southeast Missouri Behavioral Health (SEMO). While these organizations operate independently and are governed by separate board of directors, their operations and services benefit from this model. Alone, organizations may be able to navigate the current tumultuous healthcare environment, but we believe that together we can do so much more than survive. Our communities need us now more than ever, and by working together we are ready to answer their call for years to come.

Brightli Snapshot

• 200 locations

• 4 states

• 19 subsidiaries and/or affiliates

• 5k+ employees