Mental Health Care Planner

VieMed Careers•Lafayette, LA

10d•Onsite

About The Position

This position is responsible for obtaining patient demographic and health insurance information, collecting co-pays, verifying and recording insurance benefits, and obtaining prior authorization when required. The role involves interacting professionally with various healthcare professionals, patients, and their families. Key duties include scheduling referral appointments, retrieving and logging referral information, assigning patients to case managers and social workers, and reviewing medical records to determine medical necessity. The position also requires creating reports, maintaining program credentialing with insurance companies, and performing other assigned responsibilities and projects.

Requirements

High School Diploma or equivalent
One (1) to two (2) years working for a Durable Medical Equipment company
Mental Health or relevant medical office experience preferred.
Basic understandings of medical insurance benefits.
Skill in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.
Effectively communicate with social workers, patients, insurers, colleagues, and staff.
Able to read and understand medical documentation effectively.
Knowledge and understanding of same and similar DME equipment.
Knowledge and understanding of In-network vs Out of Network, PPO, HMO.
Thorough understanding and maintaining of medical insurances company's regulations and requirements to include but not limited to Medicare and Medicaid.
Working knowledge of CPT, HCPCS & ICD10 codes, MCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.
Learns and maintains knowledge of current patient database & billing system as well as Therapy Notes (VCS Digital Records).
Up to date with health information technologies and applications.
Answers telephone in a polite and professional manner.
Communicates information to appropriate personnel and management in a timely manner.
Establishes and maintains effective communication and good working relationships with co-workers, patients, organizations and the public.
Proficient in Microsoft Office, including Outlook, Word, Bonafide, Therapy Notes, Smartsheets and Excel.
Utilizes initiative, strives to maintain steady level of productivity and is self-motivated.
Access to Protected Health Information (PHI) for duties related to document and report preparation.
Policies and procedures will be strictly adhered to make sure PHI is protected as required by the HIPAA Privacy Rule.

Nice To Haves

Mental Health or relevant medical office experience

Responsibilities

Obtains patient demographic and health insurance information.
Collects co-pay(s) when appropriate.
Verifies and records insurance benefits, with the ability to understand and provide insurance breakdowns.
Obtains prior authorization if required by payer(s).
Interacts professionally with LCSW's, Case Managers, RT’s, PCC’s, Viemed Staff, patients, patient's family, and co-workers.
Schedules referral appointments, as called into VCS, by LCSW's, per policy and procedure.
Retrieves incoming referral(s) and logs demographic information into current patient database & billing system.
Assigns patients to case managers and social workers according to need.
Reviews medical records from referral(s) to determine if medical necessity has been met.
Communicates to administrative staff and/or referral source(s), if referral is acceptable or what is missing to complete referral(s).
Documents in computer system the status of referral.
Reports all concerns or issues directly to VCS Manager, Supervisor, Lead, or VCS Planner.
Creates Smartsheet and Excel reports to track referrals, SW/CM task completions.
Maintains credentialing of VCS program with Behavioral Health Insurance Companies including applying for company credentialing, LCSW individual credentialing, managing Smartsheet to track when licensures are for renewal and addressing any communications sent by the Insurance companies.
Other responsibilities and projects as assigned.