Trilogy Behavioral Healthcare Inc. strongly believes that treatment services are more effective when provided in the client’s natural setting, hence, the majority of services provided are located in the community. Trilogy Behavioral Healthcare Inc. also employs a holistic approach to each client’s treatment and integrates all facets of our clients’ lives including mental/emotional health, physical health/wellness, employment and education, social and family relationships, substance use/abuse issues, and housing needs.
Typical services provided include case management, counseling/therapy, individual skills training, medication training, crisis intervention, linkage to community resources, advocacy, assessment, and treatment planning.
The Insurance Follow Up Representative is responsible for investigating and resolving all billing claim issues (including rejections, denials, etc.)
Responsible for investigating and resolving insurance claims
Maximizes reimbursements through efficient, timely and comprehensive voucher, delinquent claim and denial management review
Prepares appeals and tracks outcomes. Complies with all contractual, state and federal requirements
Troubleshoots case issues and manages resolution to completion
Acts as a client advocate by providing information and education on health insurance benefits, billing, and the reimbursement process to our customers
Reviews and researches claims for denials reason
Prepares and files appeals timely
Completes request for reconsideration forms following payor requirements and submits with timely filing periods. Includes all applicable clinical documentation in accordance with HIPAA Privacy Standards and to ensure maximum reimbursement
Follows established Client Accounts appeal guidelines. Processes insurance/client correspondence, VOC, and ticklers follow-up based on established Trilogy Follow Up unit policies and procedures
Communicates issues regarding denial trends to supervisor
Provides exemplary customer service; treats clients and coworkers with courtesy and discretion
Presents self professionally in all communication with payors
Perform other duties as assigned
Minimum of 2 years experience in healthcare industry (particularly Medicaid and Managed Medicaid insurance companies)
Thorough knowledge of Government MCO payers
Strong Microsoft Office skillls (Word, Excel, Access, etc.)
Experience with CareLogic peferred
Highly detail oriented, with strong organizational skills
Trilogy, Inc., founded in 1971, is a private not-for-profit behavioral healthcare organization with more than 40 years of experience serving people with serious mental illness in the Chicago community of Rogers Park and its surrounding areas. Trilogy's mission is to assist people in their recovery from serious mental illness by helping them discover and reclaim their own capabilities and life dire...ction.Central to the philosophy of all Trilogy services is a belief in the possibility of long-term recovery from mental illness and mental illness with co-occurring substance use issues. We operate under the assumption that people can and do make good choices for themselves when offered accurate information, a wide array of recovery options, acceptance, and support. Our services are designed to maximize individuals' independence, self-sufficiency, and quality of life, by helping people identify their own strengths, talents and interests and to develop their own wellness recovery plans.Trilogy is a Trauma-Informed Care organization. We have an appreciation for the high prevalence of traumatic experiences in persons who receive mental health services. Every single client served by our organization experiences a safe and trusting physical and social environment that provides trauma-informed and trauma-specific services that are easily accessible; person-centered, competently delivered, culturally respectful and consistent with recovery-oriented principles of collaboration: shared decision making and self-direction.