Claims and Enrollments Analyst

Where Better Begins.

The ADAMH Board of Franklin County provides a pathway to recovery for Franklin County residents needing resources for addiction and mental health. We need you to join our team and help support the work that brings Help, Healing, Health and Hope to our community!

ADAMH is seeking a Claims and Enrollments Analyst to support a network of behavioral health providers. In this role, you will process and adjudicate claims, ensuring accuracy and alignment with internal policy and Medicaid eligibility requirements.

You will also use Excel and analytical skills to identify trends, resolve issues, and provide technical assistance to providers. This position is ideal for someone who is detail-oriented, enjoys problem-solving and using data to support system effectiveness.

What we offer:

• Starting salary range: $62,157 - $72,587
• Robust health benefits for all full-time employees, including comprehensive behavioral health support and coverage.
• Life insurance coverage for all full-time employees.
• Guaranteed 11 paid holidays every year.
• A 19% employer contribution to your OPERS pension plan.
• Generous wellness benefits and incentives for employees/spouses enrolled in healthcare plan.
• See more information on our competitive benefits programs at: https://bewell.franklincountyohio.gov/

What you’ll do:

• Performs all aspects of member enrollment and provider claims processing (employing knowledge of service providers' contracts and budgets) in accordance with established policies and procedures. 
• Acts as primary point of contact with assigned providers by promoting a one-stop customer service for provider enrollment and claiming issues.
• Responds to requests for technical support received by telephone calls, e-mail, or help desk support tickets for assigned providers. 
• Applies analytical thinking and utilizes knowledge of provider agency budgets/contracts, procedure codes, rate schedule infrastructure, benefit plans and other functional data in order to identify system issues; researches and resolves enrollment and claims issues in accordance with established policies and procedures.
• Conducts ongoing quality assurance reviews of assigned provider enrollments and claims and conducts follow-up activities with assigned provider and Sr. Claims and Enrollments Analyst when applicable.
• Reviews changes to member eligibility and performs claims re-adjudication as needed to ensure proper payments; solves other problems related to claims pricing when discrepancies arise.
• Facilitates technical assistance and quality assurance meetings with assigned providers to enhance user experience.
• Provides technical support regardin­­g enrollment and claims procedures to other ADAMH business units (Provider Relations and Fiscal).
• Delivers virtual and in-person trainings for assigned end users.
• Other duties as assigned.

What we're looking for:

Education:      High School diploma or equivalent required. Associate’s degree preferred.

Experience:     Two (2) years' work experience in healthcare billing preferred.

Skills:            Knowledge of Electronic Health/Medical Record (EHR/EMR) or practice management systems

                     Knowledge of healthcare billing/coding and claims processes.

             Knowledge of web-based training and “Help Desk” ticketing systems.

             Excellent ability to comprehend and adhere to policies/procedures and documented business rules.

             Excellent written and verbal communication, including use of e-mail and remote technology, public speaking.

             Strong training facilitation skills.

             Strong problem-solving, organization, and negotiation skills.

             Strong negotiation skill and ability to interact with staff on all levels and disciplines.

             Ability to adapt to a changing environment.

             Ability to multi-task and prioritize.

             Proficient in use of MS-Office Suite (e.g., Word, Excel, PowerPoint, Visio).

             Ability to maintain a high level of accuracy and confidentiality regarding client data, work records and files.

             Ability to work effectively independently and in team environment with a wide variety of culturally diverse consumers, staff, and public.