Insurance Pre-Certification Specialist

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

Posted on April 9th, 2012

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