UM Specialist

Seven Counties Services • Louisville, KY

2d • Remote

About The Position

This is a remote position, and only candidates residing in the Louisville Metro and Southern Indiana will be considered. The UM Specialist verifies client’s mental health, intellectual disability, and/or substance abuse benefits and obtains initial and subsequent authorizations as determined by the client’s health insurance plan. The role accurately identifies behavioral health payers per medical plan and implements a tracking system for recertification of services. The specialist secures client financial status or insurance coverage information, completes insurance forms, verifies coverage, and answers inquiries from clients, doctors' offices, or third-party payers. They explain charges, services, and bill payment policies to clients and their families. Additionally, the UM Specialist performs administrative functions to complete and expedite the billing process, including recording client data, investigating charges, updating information, and preparing claims. They also resolve billing problems and receive insurance updates. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description.

Requirements

• Completion of up to 18 months’ additional business education beyond high school.
• Two to three years of related administrative experience in an insurance or managed care setting.
• Excellent observation skills, analytical thinking, problem solving and good verbal and written communication skills.
• Basic knowledge of managed care and reimbursement concepts.
• Knowledgeable of medical terminology, CPT, HCPC, and revenue codes.
• Excellent customer service skills.
• Typing speed of 45 - 55 word units per minute.
• Basic computer skills.

Responsibilities

• Verifies client’s mental health, intellectual disability, and/or substance abuse benefits and obtains initial authorization and subsequent authorizations, as determined by client’s health insurance plan.
• Accurately identifies behavioral health payer per medical plan.
• Implements tracking system to obtain recertification of services, as needed, for psychiatrists, psychologists, licensed clinical social workers, and licensed professional counselors.
• Secures information about client’s financial status or insurance coverage and, as needed, completes insurance forms, verifies insurance coverage, and secures other relevant information.
• Answers inquiries from clients, doctors' offices, or third-party payers and follows through to resolution.
• Understands and explains to clients and their families the charges, services, and bill payment policies applicable to them.
• Performs various administrative functions to complete and expedite the billing process including, but not limited to, recording client identification data and physician diagnosis, investigating charges, correcting and updating data, and preparing the claim to bill.
• Resolves billing problems and/or receives insurance updates.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree