Psych-Pre-cert Specialist

INSIGHT Surgical Hospital•Chicago, IL

9d•Onsite

About The Position

At Insight Hospital and Medical Center- Chicago, we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents, to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet, it is our mission to deliver the most compassionate, loving, expert, and impactful care in the world to our patients. Be a part of the Insight Chicago team that provides PATIENT CARE SECOND TO NONE! If you would like to be a part of our future team, please apply now! Position Summary The Psychiatric Pre-Certification Specialist is responsible for securing insurance authorizations for psychiatric services to ensure patients can access critical mental health and substance use treatment without financial barriers. This role serves as the initial point of contact with payers, obtaining pre-certifications for various levels of psychiatric care and supporting the Utilization Review team with authorization tracking and documentation. The Pre-Cert Specialist ensures timely submission of authorization requests, accurate documentation in required systems, and effective communication with clinical teams and insurance providers.

Requirements

High School Diploma required
Minimum 2 years of experience in one or more of the following: 1. Behavioral health pre-certification 2. Psychiatric utilization review 3. Psychiatric billing or authorizations
Experience with behavioral health insurance guidelines (Medicaid/Medicare Advantage, commercial plans) required
Familiarity with psychiatric terminology, DSM-5, levels of care, and ASAM criteria for SUD required
Working knowledge of behavioral health insurance guidelines and authorization processes
Understanding of psychiatric diagnoses, levels of care, and treatment modalities
Familiarity with InterQual/MCG criteria for behavioral health
Knowledge of mental health parity laws and HIPAA requirements
Strong organizational skills and attention to detail
Excellent verbal and written communication skills for interacting with payers and clinical teams
Ability to advocate effectively with insurance providers
Proficiency with electronic medical records (Cerner preferred) and Microsoft Office (Outlook, Excel, Word)
Critical thinking and problem-solving abilities
Ability to prioritize multiple tasks and respond to time-sensitive requests
Ability to work independently and manage own caseload
Capacity to remain focused despite frequent interruptions (calls, emails, faxes)
Ability to collaborate effectively with psychiatrists, crisis teams, and utilization coordinators
Flexibility to adapt to changing payer requirements and priorities
Commitment to accuracy and thorough documentation
Ability to maintain professionalism during high-stakes insurer negotiations
Insight Employees are required to be vaccinated for COVID-19 as a condition of employment, subject to accommodation for medical or sincerely held religious beliefs.

Nice To Haves

Associate or Bachelor's degree in healthcare administration, Psychology, Social Work, or related field preferred
Relevant experience may be considered in lieu of degree
Experience with psych EMRs (Cerner preferred)
Knowledge of Illinois Medicaid managed care plans preferred
De-escalation skills for high-stakes insurer negotiations preferred

Responsibilities

Obtains pre-certifications for psychiatric-specific services
Verifies behavioral health coverage for various payers, including Medicaid, Medicare Advantage, and commercial insurance plans
Applies InterQual and MCG behavioral health criteria to validate medical necessity using psychiatric evaluations and treatment plans
Advocates with insurance providers to secure approval for psychiatric admissions
Documents all pre-certification activities and authorization decisions in systems
Utilizes psychiatric ICD-10 codes and CPT codes appropriately
Maintains accurate records of all pre-certification requests, approvals, and denials
Tracks authorization status and updates required systems in a timely manner
Collaborates with psychiatrists, crisis team members, and utilization coordinators on urgent authorization needs
Communicates pre-certification status and next steps to appropriate team members
Participates in team discussions regarding authorization requirements and payer trends
Escalates complex or urgent cases to supervisor immediately
Assists Utilization Coordinators with: 1. Psych concurrent review tracking 2. Entering authorization updates in UR systems 3. Preparing simple appeal documentation 4. Researching payer policies for behavioral health coverage
Provides backup support for UR tasks as needed
Ensures smooth handoff between pre-certification and concurrent review processes
Monitors and responds to incoming calls from payers, providers, and internal departments in a timely manner
Processes incoming faxes related to authorizations throughout the day
Ensures no voicemail or fax goes unaddressed beyond 24 hours
Escalates urgent issues to supervisor immediately
Maintains knowledge of behavioral health insurance guidelines for Medicaid, Medicare Advantage, and commercial plans
Understands and applies psychiatric terminology, DSM-5 diagnoses, levels of care, and ASAM criteria for SUD treatment
Ensures compliance with mental health parity laws and HIPAA regulations
Maintains confidentiality of all patient information

Benefits

Paid Sick Time - effective 90 days after employment
Paid Vacation Time - effective 90 days after employment
Health, vision & dental benefits - eligible at 30 days, following the 1st of the following month
Short and long-term disability and basic life insurance - after 30 days of employment

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