Insurance Precertification Technician

Conifer Park Inc•Schenectady, NY

3d•Onsite

About The Position

Insurance Precertification Technician, Inpatient Facility - Full Time, Days Conifer Park is looking for a qualified Insurance Precertification Technician for our facility in Glenville, NY. As an insurance specialist with Conifer Park, you will be responsible for verifying commercial and Medicaid insurance coverage for Intakes and reverifies benefits on patients, once admitted. This also requires working with Managed Care organizations to verify the number of days approved upfront on pending admissions and to determine what information is required upon admissions to relay to appropriate staff. Mondays - Fridays 8:00 AM - 4:30 PM Additional Job Duties: Enters benefit eligibility into the Electronic Health Record (EHR) including co-pay, deductible-pre-existing conditions, precert, NOA, detox and/or rehab coverage. Verifies eligibility on pharmacy coverage and documents in EHR. Requires working with many caseworkers and utilization review staff throughout the counties to determine Medicaid eligibility on pending intakes. Obtains and reviews temporary Medicaid cards and/or documentation from caseworkers. Contacts DSS caseworkers to assist in having restrictions removed. Requires working with MCOs to assist in resolving restricted providers on Medicaid and/or Managed Medicaid clients. Reviews admissions reports from previous day and confirms the required authorization review criteria, and documents in the EHR. Flags charts via email to alert Crisis staff that clinical assessments are required upon admission. Assess, interview and assist Clients with applications and documentation through the State of New York Marketplace Tracking, resolving and reporting Medicaid recertification, Medicaid conversion to Managed Medicaid, Medicaid restrictions, and Medicaid Pending updates. Resource to Regional staff to determine eligibility/troubleshoot eliminate roadblocks/provide resources to better assist their clients in the community. Tracking, resolving and reporting court orders on intake clients through admission process. Runs E-Paces on incoming admissions. Runs Connex on incoming admissions. Occasionally travels between Conifer Park inpatient site and Arms Acres inpatient site. Performs special projects as assigned by supervisor. Participates in Performance Improvement Initiatives.

Requirements

High school Diploma or GED with a minimum of 3 years’ experience OR 2 years/Associate’s Degree with a minimum of 1 year experience

Responsibilities

verifying commercial and Medicaid insurance coverage for Intakes
reverifies benefits on patients, once admitted
working with Managed Care organizations to verify the number of days approved upfront on pending admissions
determine what information is required upon admissions to relay to appropriate staff
Enters benefit eligibility into the Electronic Health Record (EHR) including co-pay, deductible-pre-existing conditions, precert, NOA, detox and/or rehab coverage
Verifies eligibility on pharmacy coverage and documents in EHR
working with many caseworkers and utilization review staff throughout the counties to determine Medicaid eligibility on pending intakes
Obtains and reviews temporary Medicaid cards and/or documentation from caseworkers
Contacts DSS caseworkers to assist in having restrictions removed
Requires working with MCOs to assist in resolving restricted providers on Medicaid and/or Managed Medicaid clients
Reviews admissions reports from previous day and confirms the required authorization review criteria, and documents in the EHR
Flags charts via email to alert Crisis staff that clinical assessments are required upon admission
Assess, interview and assist Clients with applications and documentation through the State of New York Marketplace Tracking, resolving and reporting Medicaid recertification, Medicaid conversion to Managed Medicaid, Medicaid restrictions, and Medicaid Pending updates
Resource to Regional staff to determine eligibility/troubleshoot eliminate roadblocks/provide resources to better assist their clients in the community
Tracking, resolving and reporting court orders on intake clients through admission process
Runs E-Paces on incoming admissions
Runs Connex on incoming admissions
Occasionally travels between Conifer Park inpatient site and Arms Acres inpatient site
Performs special projects as assigned by supervisor
Participates in Performance Improvement Initiatives