Managed Care Specialist

Caron Treatment Centers- Career•Wernersville, PA

4d•Remote

About The Position

Join a purpose-driven team at Caron Treatment Centers, where for nearly 70 years, we’ve been helping people find a path to recovery from addiction and rebuild their lives. We offer real careers with real opportunities for growth, comprehensive training, and a commitment to work-life balance. We’re proud to foster a diverse and inclusive environment, with a culture of teamwork, compassion, and dedication to our mission. Start a career that saves lives at a company that values yours! This position will be remote. Monday through Friday 8:00-4:30. Candidates should have a private workspace to handle confidential phone calls.

Requirements

CAC or BA Human Services or nursing experience required.
1+ year experience in customer service, in healthcare setting – required
Computer experience – working knowledge of Microsoft Office (Outlook, Word and Excel) or similar software - required
Excellent verbal and written communication skills required
Knowledge of addiction, 12 steps and ASAM level of placement criteria required
Ability to report promptly and regularly to work
Working knowledge of Microsoft Office
Must demonstrate skills in achieving internal and external customer satisfaction.
Will display an accurate understanding of the Treatment Planning Process, documentation, and confidentiality regulations.
Display an accurate understanding of medical necessity criteria, documentation, and confidentiality regulations.

Nice To Haves

2 years continuous sobriety preferred, if in recovery

Responsibilities

Complete initial pre-cert/concurrent and discharge reviews calls to managed care companies when needed for Caron inpatient programs.
Provide Utilization review needs as determined with benefit verification (Verbal, written, faxed or access to managed care portals) as indicated.
Fax ACT 106 prescriptions and/or required forms for treatment to manage care companies for authorizations with follow up documentation.
Complete medical records requests as it relates to authorization/discharge requests.
Complete appeal letters of medical necessity upon requests when needed.
Document accurate authorization or denial with reasons for the denials in the contact log.
Complete all necessary documentation in Aura to produce an accurate claim at time of discharge for billing purposes and tracking of statistical reporting requirements.
Rotate weekend precertification coverage including holidays.
Uphold confidentiality and professionalism at all times.
Be point person for coordination of peer-to-peer reviews as identified for contracted insurances.
Ensure proper consent to release to insurance is accurate and reflected per the funding source.
Ensure the medical level of care assessment is accurate and completed at time of admission.
Ensure documentation in the clinical record is up to date and reflective of the current level of care.