Behavioral Health Clinical Reviewer - 225575
About the Company : Medix is currently hiring LMSW or LCSW to work as a Behavioral Health Clinical Reviewer. This is a completely remote position but they must be licensed in the state of Arizona.
The Behavioral Health Claims Reviewer is responsible for conducting pre-payment, post-service claims review for various BH HCPCs codes to determine the necessity and appropriateness of services.
Equipment will be provided : Laptop, couple of monitors and cell
Schedule : Monday - Friday (8a-5p) 40 hours per week.
Type : Contract until Dec 2024
Responsibilities :
- This project is specifically aligned with AZ Medicaid-AHCCCS and CMS.
- Issues were noticed last year in regards to Behavioral Health services being billed and serviced incorrectly for AHCCCS patients.
- Evaluate and process prior authorization requests for medical procedures and medications.
- Collaborate with healthcare providers to gather necessary documentation.
- Conduct clinical assessments based on established guidelines.
- The purpose of this position is to review AHCCCS claims, both prepayment and post-service, to identify if the claim is essentially fraudulent or not.
Did these services actually happen? Were these services done, billed or coded correctly?
- Will be utilizing a lot of AHCCCS specific programs in addition to Microsoft Office apps (i.e. Excel)
- Claims per day is approx 12-18, this could vary day by day but is the average
Required Qualifications :
- LCSW or LMSW License (Arizona)
- Minimum 2 years clinical Behavioral Health Experience (acute care hospital, OP Clinic setting, etc)
- Minimum 2 years chart review experience (UM, clinical review, quality review, etc)
- Minimum 2 years remote work experience
Other Desired Qualifications :
- OP BH Claims Review (post-service and pre-payment)
- Working knowledge of OP BH HCPCs codes (ex. H0004, H2017, S9480, etc)
- Microsoft Teams
- SharePoint
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