Inpatient Utilization Management Specialist
About The Position
Participate in daily treatment team meetings in Crisis Services programs for the purpose of identifying new patients and communicating with them to determine financial income information, behavioral health and Substance Abuse insurance coverage as well as prescription medication insurance coverage. Attempt to obtain copies of insurance cards or other documentation from the patient or patient’s family/friends should intake staff be unable to procure at admission. Verify benefit coverage for all identified insurance plans, and communicate responsibilities to patients. Provide timely and accurate clinical information to third party payers as needed to assure coverage for inpatient treatment services. Provide feedback to nursing and administrative staff regarding need for documentation, denial of payment for patient treatment, or need for doctor-to-doctor consultation to assure coverage of treatment. Draft insurance appeals as needed. Responsible to assist in the reporting of ACSU Daily Census reporting, required by CFBHN.
Requirements
- High school diploma or equivalent.
- Ability to pass a level II Background clearance and drug test.
Nice To Haves
- Minimum of two (2) years’ experience in behavioral health field.
- Familiarity with health insurance, managed care organizations, third party payers and ASAM level of care criteria.
- UM experience in a health related field.
Responsibilities
- Participate in daily treatment team meetings to identify new patients and determine financial income, insurance coverage for behavioral health, substance abuse, and prescription medications.
- Obtain copies of insurance cards or other documentation from patients or their families/friends if intake staff cannot.
- Verify benefit coverage for all identified insurance plans and communicate patient responsibilities.
- Provide timely and accurate clinical information to third-party payers to ensure coverage for inpatient treatment services.
- Provide feedback to nursing and administrative staff regarding documentation needs, payment denials, or the necessity for doctor-to-doctor consultations to ensure treatment coverage.
- Draft insurance appeals as needed.
- Assist in reporting ACSU Daily Census as required by CFBHN.
Benefits
- Full-time Dental, vision, health, and life insurance.
- Employee Assistance Program (EAP).
- Employer sponsored contribution to Health Savings Account (HSA), with qualifying insurance plan.
- Paid Time Off (PTO).
- 11 paid holidays.
- 403b Retirement Plan, with 9% employer contribution for those who meet eligibility requirements.
- Tuition reimbursement.
- Public Service Loan Forgiveness (PSLF) eligible.
- Health Resources and Services Administration (HRSA) loan repayment eligible for qualifying staff.
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
High school or GED
