UM Specialist - Remote open to Louisville Metro applicants only

Seven Counties Services • Louisville, KY

7d • Remote

About The Position

The UM Specialist verifies clients’ mental health, intellectual disability, and/or substance abuse benefits and obtains initial and subsequent authorizations as determined by the guarantor. The role verifies commercial and Medicare Advantage plans for the agency at intake and processes reports related to changes in guarantors. It works daily reports to move authorizations through their lifecycle from intake to discharge, communicates guarantor needs to operations staff, and retrieves chart information for retroactive reviews and appeals. The UM Specialist collaborates with and educates operations staff about authorization processes and client request status, implements a tracking system for future authorizations and other guarantor-required maintenance, and resolves billing problems or receives insurance updates.

Candidates must live in the Louisville Metro area. The position requires a high school diploma; an associate degree is preferred, along with two years of administrative experience. The role also requires analytical and problem-solving skills, knowledge of managed care and reimbursement concepts, medical terminology, CPT, HCPC, and revenue codes, and strong customer service and communication skills. Staff are expected to exercise principle-centered leadership focused on customer service responsiveness and continuous quality improvement, and to understand and follow policies and procedures related to safety management and Joint Commission standards.

Requirements

• Live in the Louisville Metro area.
• High school diploma.
• Two years of administrative experience.
• Excellent observation skills, analytical thinking, and problem-solving skills.
• Good verbal and written communication skills.
• Basic knowledge of managed care and reimbursement concepts.
• Knowledge of medical terminology, CPT, HCPC, and revenue codes.
• Excellent customer service skills.

Nice To Haves

• Associate degree.

Responsibilities

• Verify clients’ mental health, intellectual disability, and/or substance abuse benefits and obtain initial and subsequent authorizations as determined by the guarantor.
• Verify commercial and Medicare Advantage plans for the agency at intake and process reports related to changes in guarantors.
• Work daily reports to move authorizations through their lifecycle from intake to discharge.
• Communicate guarantor needs to operations staff.
• Retrieve necessary information from charts for retroactive reviews and appeals.
• Collaborate with and educate operations staff on the authorization process and the status of client requests.
• Implement a tracking system to obtain future authorizations and complete other maintenance required by guarantors.
• Resolve billing problems and/or receive insurance updates.
• Follow applicable safety management policies and procedures and Joint Commission standards.

What This Job Offers

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