Responsible for reviewing client insurance benefits and ascertaining level of care (LOC) pre-certifications. Also resposible for admissions coordination
Essential Duties and Responsibilities
- Reviews and understands insurance information provided by the Call Center, determines which benefits are available to client, and clarifies discrepancies or confusion.
- Completes a thorough review of all clinical documentation. As needed meets with the client upon admission or soon thereafter to complete pre-certification information.
- Determines what LOC the client meets and what ASAM (American Society of Addiction Medicine) and/or health plan criteria support that LOC based on clients benefits.
- Once a care manager is established, contacts health plan provider and requests most appropriate LOC for client.
- Documents in system and in a paper file the request made and authorization approval number/contact information.
- Reviews and enters daily and weekly UR update information into electronic medical records and billing software
- Census tracking and data updates
- Attends Flash Meetings as Assigned
- Coordinates all aspects of admission from travel into facility, to securing financial documentation, assisting with coordination of treatment services, referral source communcation, collections, case management as needed.
- Performs all other duties as required or assigned.
Knowledge, Skills and Abilities
- Knowledge in electronic medical records
- Knowledge in insurance billing software
- Ability to inspire client confidence in the FRN Staff and the FRN Model of Treatment.
- Ability to consistently demonstrate through conduct and communications the stability required to effectively assist patients and their family members through the FRN Model of Treatment.
- Excellent verbal and written communication skills required.
- Must have high level of interpersonal skills. Position continually requires demonstrated professionalism, tact and diplomacy.
- Specific knowledge of substance abuse and or mental health treatment on a clinical level.
- Ability to understand insurance benefits and follow insurance protocols within appropriate time frames.
- Ability to learn levels of care guidelines and medical necessity criteria.
- Must have strong knowledge of a variety of computer software applications in word processing and spreadsheets (MS Word, Excel).
- Excellent organizational skills with the ability to prioritize workload and meet deadlines.
- Ability to pay continual attention to detail in documenting files.
- Understands need for and maintains appropriate confidentiality at all times when interacting with patients, residents, families, visitors, referral sources and all other contacts.
- Exhibits excellent customer relation skills as evidenced by supportive and constructive communication with all contacts including coworkers, patients, residents, visitors, families and referral sources.
- Must possess a current, valid drivers license
Education and Experience
- LVN/RN level Nursing or Masters degree in psychology, MFT, social work, or related field required.
- Minimum of 2 years experience working in a substance dual diagnosis facility with client contact.
- Minimum of 1 year experience working in a managed care position.
- Licensure and CADC certification in addictions preferred.
Work Environment and Physical Demands
- Ability to be physically mobile; however, long periods of sitting will be required.
- Ability to lift up to 20 lbs.
- Constant use of computer requiring manual dexterity and visual acuity.
- Ability to read, write and analyze detailed and complex information.
- 10 months ago - save job