Business Details
Behavioral Health Insurance Claims Management Experts
SJ Health Insurance Advocates (SJHIA) is a dedicated health insurance claims management and advocacy firm committed to navigating the complexities of insurance reimbursement. Our mission centers on ensuring clients receive timely and accurate compensation from health insurance providers while upholding the highest ethical standards. With a team of licensed behavioral health professionals, A/R specialists, and regulatory experts, we specialize in verification of benefits, appeals processes, utilization reviews, and comprehensive claims management.Our vision drives us to minimize bureaucratic hurdles for clients, combining industry-leading technology with personalized service to reduce denials and enhance revenue cycles. Founded by Scott Leshin after his personal struggles with insurance systems, our company prioritizes client-first values and leverages decades of collective expertise to deliver tailored solutions for behavioral health providers.
Services
Verification of Benefits
Appeals Process
Utilization Review
Claims Tracking
Quality Assurance
Relationship Management
Billing Collections
Analytics Reporting
Highlights and features
- We employ licensed behavioral health professionals for clinical insurance advocacy
- Our 24/7 reporting portal provides real-time claims and utilization insights
- Custom KPI reporting tailored to each client's unique operational needs
- Specialized in reducing denials through rigorous quality assurance processes
- Founder's personal experience drives our patient-centric insurance solutions
Services
Verification of Benefits
Our verification process ensures accurate insurance benefit assessments through direct carrier communication. We document coverage details in standardized templates to increase admissions and clarify reimbursement expectations. This service provides critical insights into claims payment structures for behavioral health treatment centers.
Appeals Process
We develop comprehensive appeal strategies for denied treatments using medical records analysis. Our licensed clinicians handle all appeal levels, including external reviews with regulatory bodies. This service maximizes reimbursement opportunities through evidence-based clinical arguments during insurance disputes.
Utilization Review
Licensed professionals manage preauthorization and concurrent reviews while conducting peer-to-peer appeals with insurance medical directors. This service ensures continued treatment authorization through clinical necessity documentation throughout patient care cycles.
Quality Assurance
Our thirteen-step verification process identifies payment discrepancies beyond initial adjudication. Automated reporting tools detect reimbursement anomalies while analysts ensure payments match contractual terms and policy specifications for maximum revenue recovery.
Analytics & Reporting
Custom KPI dashboards track reimbursement trends, authorization success rates, and payment timelines. Real-time data access enables informed decisions about treatment levels and carrier performance through interactive, HIPAA-compliant reporting platforms.
People
Scott Leshin
Founder/CEO
Bachelors and Masters in Business Administration from Syracuse University and NYU Stern. 16-year Wall Street veteran with Goldman Sachs and Morgan Stanley. Founded SJHIA after navigating insurance challenges for his son with cerebral palsy.
Stewart Ashenberg
Director of Finance & HR
20+ years finance industry experience with focus on medical billing. Holds Information Studies degree from Syracuse University. Manages financial operations and HR services for insurance verification teams.
Michelle Forrester
Director of Operations
Client relations expert with healthcare administration background. Oversees client connections and billing profile support. Focuses on maintaining relationships that differentiate SJHIA from competitors through personalized service approaches.
Natalie Diken
Utilization Management Manager
8+ years behavioral health experience including roles in admissions, operations, and recovery coaching. Former utilization management director for PHP/IOP programs. Leads team securing treatment authorizations through insurance carrier communications.
Lee Rosenblum
Vice President, Client Relationship Management
Masters in Telecommunications from NYU with 20+ years corporate customer service experience. Oversees complete billing processes from facility entry through claims adjudication while providing data-driven solutions for insurance challenges.
Questions
What services does SJ Health Insurance Advocates provide?
We offer verification of benefits, claims management, appeals processing, utilization reviews, and real-time analytics for behavioral health providers.
How does your claims verification process work?
Our team conducts thorough insurance benefit checks using standardized templates to ensure accurate reimbursement expectations for treatment centers.
Can you handle complex insurance appeals?
Yes, our licensed clinicians prepare detailed appeals including external regulatory submissions to maximize claim approvals.
Do you offer customized reporting solutions?
We provide tailored KPI dashboards and custom report development to meet specific facility data needs.
How do you ensure billing accuracy?
Thirteen quality assurance steps verify payments align with policy terms, with anomaly detection for underpayments.
