Insurance Specialist

NATIVE AMERICAN MENTAL HEALTH SERVICES CORPORATION•Redding, IA

11d•$19 - $22

About The Position

An Insurance Specialist is responsible for obtaining prior authorization for clients seeking therapy and medication management services through NAMHS. It is the responsibility of the Insurance Specialist to act as the liaison between the client, insurance company, and clinical team to assure the client’s insurance authorizes the services needed prior to DOS. The Insurance Specialist will assist the central access scheduler in preregistration and new patient scheduling, as needed. The Insurance Specialist will need to work quickly and efficiently to ensure timeliness in care for clients seeking services at NAMHS. DUTIES AND RESPONSIBILITIES: Insurance Verification: - Verify Insurance by checking patients' insurance coverage to determine if prior authorization is required for specific mental health services. -Preparing and submitting prior authorization requests to insurance companies, including gathering necessary medical documentation and patient information in a timely manner. -Act as a liaison between clients, clinician and admin staff to obtain additional clinical documentation as needed for prior authorization -Communicating with insurance companies to track the status of prior authorization requests, addressing any issues or additional information requests promptly. -Handling denials of prior authorization requests by submitting appeals, providing additional documentation, and working with healthcare providers to revise requests if needed. -Coordinate payment plans when applicable and/or self-pay expectations for new clients. -Maintain open lines of communication with patients, providers, and insurance companies to address any inquiries or concerns related to referrals. -Communicate effectively with patients regarding their appointments, insurance-related matters, and any other relevant information. New Patient Management and Registration: -Coordinate and schedule appointments for referred patients with mental healthcare providers as needed. -Communicate referral details to patients, including appointment information, pre-visit instructions, and any necessary documentation. -Communicate to the patient the need to be able to connect with zoom to allow for virtual appointments. -Manage INITIAL appointment scheduling and rescheduling to optimize clinic/provider efficiency to support the Central Access Schedulers, as needed -Follow up with referring offices as needed. Documentation and Record-Keeping: -Accurately document and maintain electronic and paper records of all referrals, including patient information, appointment details, and communication history. -Ensure compliance with healthcare regulations and organizational policies in the documentation process. Customer Service: -Provide excellent customer service to patients, healthcare providers, and insurance companies, addressing inquiries and concerns in a professional and timely manner. -Receive and respond to patient and staff needs and complaints appropriately within the realm of the “patient care” environment, involving department supervisors and patient representatives as needed. -Provide follow up communication with the referring source -Act as the point of contact for patients seeking information about initial services, procedures, and general inquiries.

Requirements

Knowledge and understanding of medical terminology and insurance providers.
One year of experience preferred with insurance verification of eligibility and benefits
One year of experience obtaining prior authorizations
Ability to organize and prioritize work.
Ability to manage multiple priorities.
Excellent verbal and written communication skills including letters, memos and emails.
Excellent attention to detail.
Ability to research and analyze data.
Ability to work independently with minimal supervision.
Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization.
Proficient use of Microsoft Office applications (Word, Excel, Outlook) and internet resources.

Nice To Haves

Previous experience working with Managed Medi-Cal, Medicare, PPO and HMO plans as it relates to behavioral health services preferred

Responsibilities

Verify Insurance by checking patients' insurance coverage to determine if prior authorization is required for specific mental health services.
Preparing and submitting prior authorization requests to insurance companies, including gathering necessary medical documentation and patient information in a timely manner.
Act as a liaison between clients, clinician and admin staff to obtain additional clinical documentation as needed for prior authorization
Communicating with insurance companies to track the status of prior authorization requests, addressing any issues or additional information requests promptly.
Handling denials of prior authorization requests by submitting appeals, providing additional documentation, and working with healthcare providers to revise requests if needed.
Coordinate payment plans when applicable and/or self-pay expectations for new clients.
Maintain open lines of communication with patients, providers, and insurance companies to address any inquiries or concerns related to referrals.
Communicate effectively with patients regarding their appointments, insurance-related matters, and any other relevant information.
Coordinate and schedule appointments for referred patients with mental healthcare providers as needed.
Communicate referral details to patients, including appointment information, pre-visit instructions, and any necessary documentation.
Communicate to the patient the need to be able to connect with zoom to allow for virtual appointments.
Manage INITIAL appointment scheduling and rescheduling to optimize clinic/provider efficiency to support the Central Access Schedulers, as needed
Follow up with referring offices as needed.
Accurately document and maintain electronic and paper records of all referrals, including patient information, appointment details, and communication history.
Ensure compliance with healthcare regulations and organizational policies in the documentation process.
Provide excellent customer service to patients, healthcare providers, and insurance companies, addressing inquiries and concerns in a professional and timely manner.
Receive and respond to patient and staff needs and complaints appropriately within the realm of the “patient care” environment, involving department supervisors and patient representatives as needed.
Provide follow up communication with the referring source
Act as the point of contact for patients seeking information about initial services, procedures, and general inquiries.