Overview
PURPOSE STATEMENT:
Assist the care management team in providing a seamless continuum of care.
Responsibilities
ESSENTIAL FUNCTIONS:
- Provide assistance in seamless communication between the insurance companies by checking outcomes of precert clinical, concurrent reviews, doctor to doctor and denial results.
- Provide communication with the Finance Department and treatment team on insurance denials and status.
- Facilitate appropriate appeal process, as determined by the insurance provider, in cases of denial in collaboration with patients, families/guarantors and the Finance Department.
- Provide assistance in seamless communication with the Finance Department on insurance status and insurance denials.
- Assist in prompt communication of discharge plans that is required by insurance companies.
- Facilitate appropriate appeal process in cases of denial in collaboration with the guarantor and the Finance Department.
- Make copies of insurance company’s request of patient medical records and send via fax or mail as instructed.
- Assist the department in obtaining supplies and maintaining organization. Provide excellent customer service via phone and in person.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
Qualifications
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- High school diploma or equivalent required.
- Associate's degree preferred. One or more years of experience working in behavioral health setting. Experience with the patient population served by the facility preferred. Previous experience in case management and/or utilization review preferred.
LICENSES/DESIGNATIONS/CERTIFICATIONS: ☐
- CPR and de-escalation/restraint certification required (training available upon hire and offered by facility).
- First aid may be required based on state or facility.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.
