Insurance Pre-Certification Specialist

Posted on April 9th, 2012

Job Summary
Insurance Precertification Specialists (IPS) acts as liaison between the insurance companies, JHC’s facilities and families, verifies insurance eligibility and benefits, and obtains pre-certification/ preauthorization for treatment at all levels of care, obtaining maximum benefits for JHC’s guests.

Qualifications

  1. 2 or more years experience in the healthcare industry – preferably in mental health/addiction arena.
  2. Working knowledge of clinical case formulation for substance abuse/mental health treatment.
  3. Working knowledge of managed care in all areas – most importantly:
    1. Insurance verification (VOB)
    2. Pre-Certification/Utilization Review
    3. ASAM Criteria
    4. Addiction/Mental Health terminology
  4. Familiar with ICD-9 codes, billing codes, DSM VI TR diagnostic codes and CPT coding
  5. Ability to prioritize, multi-task and meet strict deadlines.  Strong Organization skills and dedication to continuous learning in field.
  6. Able to work under pressure and communicate effectively (verbally and written), maintaining a professional manner.
  7. Active Listener – Giving full attention to conversations, asking appropriate questions, comprehend the points being made and great judgment of situations.  Negotiation skills.
  8. Able to pass a Background Clearance.
  9. Advanced Computer Skills (mac platforms, word, excel, etc). Excellent data entry skills.
  10. Knowledge of HIPPA Guidelines and federal substance abuse treatment confidentiality guidelines.

Duties and Responsibilities – to include but not limited to:

  • Verification of Benefits for potential guests and current guests of JHC
    • Obtaining VOB prior to treatment or at 1st knowledge of guest wanting to use insurance.
    • Proper and complete documentation of VOB
    • Informing Admissions and Clinical of results
      • Clinical if there is a limited timeframe for the assessment
  • Speaking with Guests/Financial Responsible Party
    • Insurance Process – once committed to treatment at JHC
    • Proper insurance documentation signed by Responsible Party/Guest
    • Updates of where Insurance Process is at
  • Pre Certification/Authorization
    • Pre Certification Assessment via phone (UT), in person (AZ)
    • Contacting Insurance Companies within 24 hours or as required based off VOB to obtain Authorization for treatment
    • Concurrent reviews as required
    • Obtaining authorization and continued authorization for medical necessity based off ASAM criteria and Clinical Recommendations
      • Initial tx, extensions, discharge dates, IOP, etc
    • Proper documentation of all interactions with insurance companies, responsible party and guest
    • Close communication with Clinical Managers, Clinical Director and Billing on status of insurance

Duties and Responsibilities – to include but not limited to:

  • Verification of Benefits for potential guests and current guests of JHC
  • Speaking with Guests/Financial Responsible Party
  • Pre Certification/Authorization
    • Pre Certification Assessment via phone (UT), in person (AZ)
    • Contacting Insurance Companies within 24 hours or as required based off VOB to obtain Authorization for treatment
    • Concurrent reviews as required
    • Obtaining authorization and continued authorization for medical necessity based off ASAM criteria and Clinical Recommendations
      • Initial tx, extensions, discharge dates, IOP, etc
    • Proper documentation of all interactions with insurance companies, responsible party and guests
    • Close communication with Clinical Managers, Clinical Director and Billing on status of insurance
    • Communication with guest/responsible party in regards to insurance status
  • Billing
    • Document in Billing System claim is ready for billing to submit
    • Constant and Timely Communication with client and/or responsible party on balances due based off insurance claim reimbursement.

For more information about this job or to apply for it call: 844-877-2806

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