Manager, Healthcare Business Operations

Aptihealth Troy , NY 12180

Posted 6 days ago

Life at aptihealth

The aptihealth team are health care, technology, research, and user experience experts passionate about transforming behavioral healthcare. Everything we do at aptihealth is centered around our mission to revolutionize care and to ensure that the millions of people who need and deserve it have access to it. As a curious and collaborative teammate, someone excited about tackling the hard problems in healthcare and technology, you will play a key role in making that mission a reality. Together, we will create and innovate transformative behavioral healthcare for millions of people.

aptihealth, inc. offers access to virtual behavioral health services to health plans and systems for the benefit of their members and patients. aptihealth Medical Group, PLLC, operating under a services agreement with aptihealth, inc. provides licensed behavioral health services to aptihealth members.

Role

As the Manager, Business Operations, you will be responsible for leading the business operations for a rapidly growing teletherapy practice including behavioral health providers (LCSW, LMHC, Psychiatrist) and psychiatric prescribers (NP/PA) delivering intelligent integrated care. You will be responsible for all aspects of the revenue cycle. Practice providers are utilizing an intuitive platform centered on proven, evidenced based, AI assisted care that speeds access, treatment and recovery of members with mild to severe acuity.

In coordination with our clinical operations team, behavioral providers and billing and claims processing partner, you will drive effectiveness and efficiencies in patient registration, insurance verification, co-pay processing, coding (CPT / ICD 10), billing and claims processing.

If you want be part of a company that is engaging smarter for better outcomes, ultimately impacting the lives of millions of people, then this is the role for you. You'll be happy here if you have a passion for insight, execution, results, and moving fast.

*Candidates located near Boston, MA or Troy, NY will be considered

Responsibilities

  • Manage relationships with various payers in partnership with our billing and claims processing partner
  • Contact payers for Eligibility Verification and to resolve billing issues
  • File claims to ensure maximum entitled reimbursement
  • Verify completeness and accuracy of all claims prior to submission & submit with zero errors.
  • Read and interpret explanations of benefits
  • Respond to inquiries from payers, members, and providers
  • Regularly meet with billing and claim processing partner to resolve reimbursement issues and/or billing obstacles
  • Document standard operating procedures and guidelines to and ensure quality and consistency of reviews
  • Drive product guidelines to ensure coding guidelines are adhered to in all claim reviews
  • Work closely with the Practice leadership to manage any claim matters that require clinical leadership involvement
  • Identify and correct discrepancies based on coding guidelines, coding sources, and/or processes and make recommendations of updates and changes
  • Utilize data analytics to manage current claim criteria as well as create new opportunities for growth expansion within claim reviews
  • Manage and track KPIs associated with claim reviews
  • Maintain awareness of and ensure adherence standards regarding privacy policies
  • Perform other duties as needed

Requirements

  • Bachelors Degree in Finance, Accounting or Related Business Field
  • 5+ years healthcare operations experience including medical coding, billing & claims experience a must
  • Experience and working knowledge of health insurance, Medicare guidelines and various healthcare programs
  • Experience with patient registration and insurance verification process
  • Experience with co-pay and deductible processing along with claims appeals processes
  • Highly organized with attention to detail
  • Strong analytic skills regarding data requests and reporting
  • Passionate about being a trusted partner to transform behavioral healthcare
  • Results driven -- documented success in exceeding goals and objectives
  • Ability to thrive in a fast paced, constantly changing environment
  • Excellent communication and presentation skills, both verbally and in writing.
  • Proficiency in use of Microsoft Office programs, including Word, Excel and Outlook, and Internet search tools
  • Strong interpersonal and relationship building skills and the skills necessary to drive change and innovation
  • Demonstrated commitment to the core values of the company
  • Demonstrated effectiveness in cross-departmental collaboration
  • Experience working in start-up environment is preferred
  • Management experience is preferred

Benefits

  • The opportunity to make life better for millions of people
  • An environment of positive and super smart colleagues
  • Turning innovative ideas into real-world results
  • Encouraging curiosity and collaboration
  • Priding ourselves in being diverse and inclusive
  • Fostering a company of trust & accountability
  • Competitive pay and benefits
  • Investment in our team with continuous learning opportunities
  • Balancing extraordinary work with your personal life
  • Flexible working hours and lots of freedom in your work habits
  • Embracing social responsibility with time off for community service projects

About aptihealth

aptihealth, inc. is a behavioral health engagement company that seamlessly integrates physical and behavioral healthcare. Our platform connects medical providers, behavioral health specialists and patients with our proprietary assessment and treatment management protocols to get and keep patients healthier faster. aptihealths structured therapy programs are centered on its proprietary 15 Life Domain Clinical Framework that efficiently provides collaborative care teams with the most thorough understanding of a patients behavioral health needs. The aptihealth platform connects patients and their care teams with licensed behavioral health specialists who provide 90-day and extended care therapy by phone or video supported by an easy-to-use consumer friendly digital experience. The aptihealth program is evidenced to get individuals into therapy faster and clinically proven to improve both behavioral and medical outcomes while lowering overall cost. aptihealths investors include Hudson River Capital Holdings, KASA Investments and Timber IV.

At aptihealth, we dont just accept differencewe celebrate it, we support it, and we thrive on it for the benefit of our team, products and community. aptihealth is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. If you have a disability or special need that requires accommodation, please let us know by contacting us.

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Manager, Healthcare Business Operations

Aptihealth