UR Specialist / Intake Coordinator
Foundations Recovery Network - Malibu, CA

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Position Summary

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.

About this company
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