Mental Health Care Planner

VieMed Healthcare•Lafayette, LA

4h•Onsite

About The Position

This position is responsible for obtaining patient demographic and health insurance information, verifying and recording insurance benefits, and obtaining prior authorization when required. The role involves scheduling referral appointments, logging demographic information, assigning patients to case managers and social workers, and reviewing medical records to determine medical necessity. The Mental Health Care Planner will also communicate referral status, create reports, and maintain the credentialing of the VCS program with Behavioral Health Insurance Companies. This role requires strict adherence to HIPAA policies and procedures for handling Protected Health Information (PHI).

Requirements

High School Diploma or equivalent
One (1) to two (2) years working for a Durable Medical Equipment company
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.
Must handle Protected Health Information (PHI) in accordance with HIPAA Privacy Rule.

Nice To Haves

Mental Health or relevant medical office experience preferred.

Responsibilities

Obtains patient demographic and health insurance information and collects co-pays when appropriate.
Verifies and records insurance benefits, understanding and providing 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 a referral is acceptable or what is missing to complete referral(s).
Documents the status of referrals in the computer system.
Reports all concerns or issues directly to VCS Manager, Supervisor, Lead, or VCS Planner.
Creates Smartsheet and Excel reports to track referrals and SW/CM task completions.
Maintains credentialing of VCS program with Behavioral Health Insurance Companies, including applying for company credentialing, LCSW individual credentialing, managing Smartsheet for license renewals, and addressing communications from insurance companies.
Performs other responsibilities and projects as assigned.