General Statement of Duties:
The incumbent oversees agency efforts to maximize managed care reimbursements by proactively tracking new authorizations, assisting in the reauthorization process, and maintaining up-to-date information on payer requirements. Develops and maintains strong knowledge base of various managed care contracts and credentialing requirements. Fosters positive communication with managed care representatives.
The incumbent will serve as the central liaison with managed care representatives. The incumbent may interact with consumers and/or their families related to the managed care authorization process. The incumbent works collaboratively with administrative, reimbursement, and clinical staff on the overall goal of maximizing agency revenue. This position is supervised by the Compliance Supervisor.
This position is classified as non-exempt under the Fair Labor Standard Act.
Distinguishing Features of Work:
The incumbent performs under minimal day-to-day supervision a range of technical responsibilities requiring independent judgment, the application of information management techniques, and the ability to organize and prioritize a large number of time sensitive tasks. The incumbent must have excellent verbal communication skills and also be able to communicate effectively in writing.
Major Duties and Requirements:
Checks insurance of all clients and oversees the authorizations process.
Obtains managed care authorizations for intake and/or initial clinic services within required time frames and communicates necessary information to reimbursement and clinical staff;
Tracks and/or obtains ongoing authorizations for specific staff members or program areas
Maintains current knowledge of insurance companies and other payers to ensure up-to-date information regarding requirements for maximum reimbursement for CSB services provided;
Maintains current knowledge of CSB clinical staff, their respective credentials, and their status as approved providers with each payer source. May assist with preparing, processing, and renewing provider applications and other staff credentialing activities;
Conveys information for accurate tracking of authorizations through use of the electronic health record notifications and reports
Maintains open and positive communication with managed care representatives and with clinical and reimbursement staff involved in managed care;
Monitors managed care re-authorization process and alerts staff to potential problem areas and assists in problem solving;
Maintains thorough understanding of all insurance payer sources and works closely with staff to insure optimal reimbursement from the funding source;
Provides technical support and training to clinical staff regarding agency processes for obtaining authorizations;
Provides direct assistance to clinical staff with authorization lapses that jeopardize revenue.
May follow up with individual clients regarding authorizations.
Maintains knowledge of State and Federal changes to regulations for service areas for maximum reimbursement.
Supports, and when directed by supervisor, carries out other departmental functions including quality improvement monitoring of agency solutions to reimbursement/clinical issues to insure appropriate implementation and outcomes plus coordination of training activities;
Investigates and follows up on identified reimbursement issues (e.g. changes in covered services, payer practices, and/or clinical practices, etc);
Supports, and at times, may directly assist in ongoing reimbursement functions that result in increased overall revenue for the agency (e.g. unpaid claims, authorization lapses, etc);
Provides technical assistance with the development of and changes to electronic health record forms and templates and other data driven tasks. Incumbent may work closely with Clinical, IT and Compliance Supervisor to ensure the functionality of the electronic health record forms and templates provides the structure for the desired clinical documentation results, and assist with other agency information and presentation distribution;
Creates templates and forms in EHR per program, service and/or regulation changes.
Participate as interest and need is relevant in limited off-hour coverage for required regulatory reporting and authorization;
Assures compliance with agency policies and all regulatory requirements;
Makes effective use of available technology, including computers, e-mail, and voice mail in order to enhance customer service;
Maintains and assures effective relationships with coworkers and customers based on courtesy, compassion and respect;
Performs duties in accordance with CSB policies and procedures, and performs other duties as assigned.
Required Knowledge, Skills and Abilities:
Thorough knowledge of the principles and practices of managed care. Knowledge of behavioral health services, medical necessity, levels of care, and requisite record keeping and documentation. Ability to collect information on third-party payer(s) regarding benefits, reimbursement requirements and authorization procedures. Strong computer and data management skills, plus excellent attention to detail(s). Ability to organize and manage multiple tasks simultaneously and the ability to coordinate responsibilities with the work of others. Excellent communication skills and the ability to articulate technical details in an understandable manner to others within both written and verbal modalities; excellent judgment; dependability; efficiency; and confidentiality.
Minimum Education and Experience:
Graduation from an accredited college or university with a bachelor degree in human services, business, public administration or a related area; two years experience working with managed care and/or behavioral healthcare, or, any equivalent combination of experience and training which provides the required knowledge, skills and abilities.
Equipment: Telephone, computer, fax, copier.
Work Environment: Behavioral healthcare setting with routine office lighting levels, temperature ranges, air quality, ventilation, and noise levels.
Work Location: 1241 North Main Street, Harrisonburg, Virginia.
Work Hazards: Standard hazards associated with general day-to-day behavioral healthcare operations; occasional hazards associated with problem behaviors.
Work Schedule: Full-time, Monday through Friday, regular office hours. Schedule is set and may be adjusted by the Compliance Supervisor in consideration of factors that will maximize the effectiveness of this position. If scheduled, some evening, weekend,
or additional hours may be required on occasion to perform job requirements. Regular attendance is required.