UM Specialist - Remote open to Louisville Metro applicants only

Seven Counties Services • Louisville, KY

1d • Remote

About The Position

Consideration will only be given only to candidates living in the Louisville Metro area. The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description. Within the bounds of their respective job descriptions, all staff are expected to exercise principle-centered leadership, focusing on customer service responsiveness and continuous quality improvement. Additionally, all staff are expected to develop a working knowledge of and follow all policies and procedures related to safety management and other Joint Commission standards.

Requirements

• 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

Nice To Haves

• Associate degree preferred.

Responsibilities

• Verifies client’s mental health, intellectual disability, and/or substance abuse benefits and obtains initial authorization and subsequent authorizations, as determined by guarantor.
• Verifies all commercial and Medicare Advantage plans for agency at intake and all reports related to changes to these guarantors.
• Works daily reports to move authorizations through life cycle of authorization from intake to discharge.
• Communicates guarantors needs to operations staff.
• Pulls necessary information from charts for retro reviews and appeals.
• Collaborates and educates operations staff on authorization process and status of their client’s request.
• Implements tracking system to obtain future authorizations and any other maintenance needed by guarantor.
• Resolves billing problems and/or receives insurance updates.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED