About River Edge Behavioral Health
Serving more than 10,000 Georgians, River Edge continues to be one of the state's leading resources for mental health, substance use disorder treatments and supports as well as individuals with intellectual and development disabilities. River Edge offers outpatient services at our Emery Highway-Macon, Monroe County and Baldwin County locations. Outpatient services include behavioral health, nursing, and psychiatric assessment, stabilization and medication maintenance services as well as crisis intervention services as well as awareness, education and recovery groups.
River Edge Behavioral Health is recognized for its state-of-the-art treatment and support services for more than 13,000 children, youth, families, and adults annually who experience mental illness, addiction, co-occurring disorders, and substance abuse problems. In addition, River Edge offers services for individuals with intellectual and developmental disabilities.
Benefits Offered:

• Competitive Pay
• Medical, Dental, Vision Insurance
• Paid Time Off
• 12 Paid Holidays
• 401k with an employer match
• Flexible Spending Accounts
• Short and Long-term disability coverage
• Life Insurance
• Employee Discount Program

Location: 175 Emery Highway, Macon, GA 31217
Schedule: Monday-Friday 8:30am-5:00pm
Responsibilities:

• Electronically post payments, manually post adjustments and denials.
• Resubmit denied claims for reprocessing CMO (Amerigroup, Cenpatico and WellCare) payment and denial processing.
• Batch and submit commercial insurance monthly.
• Post payments for commercial insurance; Post commercial insurance denials monthly.
• Call insurance company to have denied claims reprocessed that were denied incorrectly.
• Approve and apply cash sheets.
• Payer change updates in ECR-5-20 minutes per change, completed as need is identified.
• Authorization flip/split because of payer changes 30 minutes -1 hour, maybe more per client, must manually end date and reenter each service line for all authorized services. - Completed as need is identified
• Back up for Eligibility and Point of Entry- as need arises, time depends on staff availability. Varies from minutes to an entire day.
• Eligibility- if payer changes - follows process for payer change 10-20 minutes per client.
• Submit requisitions for office supplies needed. 20-30 minutes depending on supplies needed, monthly, or every other month.
• Write of CMO claims monthly- failed claims for which authorization was not obtained timely
• Prepare spreadsheets for all payments processed
• Aid clerical staff for payer updates, registration and financial application documents 5-30 minutes as needed, depending on nature or request/issue.
• Research issue, compile print screens for training/educating staff to avoid future issues/errors, monitor for correction and update Registration; additional 10-15 minutes
• Care Logic Billing Admin Email correction requests, except for un signing documents (unless requested by supervisor or UM Director)
• Status correction request 5-10 minutes per request Time correction request 5 minutes per request
• Duplicate Record Notifications 30 minutes - 1 hour per request, as requests are received
• Reverse/back out claims
• Re-schedule activity and attach downloaded document from duplicate file Blackbox, Discharge record
• CSU activity/program error corrections 15-20 minutes for activity as requested/ 30 mins plus for program corrections depending on the number of claims attached and nature of error, as requested
• Payer corrections/additions/updates 20-30 minutes per request, depending on the number of claims and authorizations, as requested/received.
• Rejection reports for Amerigroup, Cenpatico, Medicaid, Medicare SCS and Well Care 1-4 hours weekly, depending on the number and nature of rejections. Some rejections require correction from staff before re-submission. Some rejections require vendor/ state intervention which may result in multiple emails/calls.
• Provide backup assistance to submit weekly batches to Amerigroup, Beacon, Cenpatico, Medicaid, and WellCare; and submit batches to Medicare Monthly. 1- 2 hours, depending on batch creation response time and website response for submission-
• Completed weekly for ACS, SCS and CMO, monthly for Medicare.

to Monitor for successful submission; if file is rejected additional review and research required; depending on the error it may take 30 - 45 minutes to correct and resolve and resubmit.

• Approve claims daily 1-3 hours each day, depending on the number of claims in approval and the number of errors found, sometimes it takes longer.
• Research for trend, training potential and/or clarify and fix.
• Print screens and compose email with detail 5-10 minutes per client; monitor for response.
• Reverse daily until the issue is resolved.
• Some issues require reversing claims, un-signing each service document one by one by one (group/peer) 20- 30 minutes additional time.
• Provide backup assistance to Import Amerigroup, Cenpatico, Medicaid, Medicare, SCS and WellCare payment files (Medicaid and SCS Weekly, CMO's and Medicare as payments/files arrive) .15-20 minutes per file weekly.
• Run Open Bill Reports for payers monthly to research and address outstanding balances.

Qualifications Needed (education and/or experience):

• At least a high school diploma/GED equivalent.
• Must be 21 years of age.
• Proficient in Microsoft Office.
• Positive energy person, good communicator.
• Can handle and protect confidential information.

Additional Information:
The Application Process
All qualified applicants will be considered.
This position is subject to close once a satisfactory candidate pool has been identified.
The hiring managers will contact only those selected for an interview.
Applicants who are not selected will receive notification via email.
Safe Working Environment
We at River Edge believe every employee has a right to a safe work environment. Therefore, we recommend full vaccination of all employees. Getting the vaccine, frequently washing your hands, sanitizing common areas, and wearing your mask
continues to be the most effective way to fight.
Diversity and Inclusion
River Edge Behavioral Health is committed to creating a diverse and inclusive work environment and is proud to be an equal employment opportunity employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, gender, gender identity or expression, sexual orientation, nationality, genetic make-up, disability, age, or veteran status.
Drug-Free Workplace
River Edge Behavioral Health is a drug-free workplace with a longstanding commitment to providing a safe, quality-oriented, and productive work environment. In compliance with the Drug-Free Workplace Act of 1998, all applicants must pass a satisfactory background clearance and pre-employment drug screen.
At Will Workplace
Employment with River Edge Behavioral Health is at will. At-will means your employment relationship with River Edge Behavioral Health or Affordable Business Solution is for an indefinite period and is subject to termination by you or River Edge Behavioral Health, with or without cause, with or without notice, and at any time.
River Edge Behavioral Health is an Equal Opportunity Employer: River Edge Behavioral Heath recruits qualified candidates for positions in its service area. It is the policy of River Edge Behavioral Health provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination or harassment of any type without regard to race, color, sex, religion, national origin, age, disability, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
If you are looking for an opportunity to make life better and a strong desire for personal growth we encourage you to apply. We promptly review all applications. Highly qualified candidates will be contacted for interviews.
We are an equal opportunity employer and highly value diversity. We do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
All selected applicants must pass a satisfactory background clearance and pre-employment drug test.