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