UM Specialist Remote for Louisville Metro candidates only

Seven Counties Services•Louisville, KY

8d•Remote

About The Position

PURPOSE Position is open to Kentucky and Southern Indiana residents only. Some in office work while training may be required. ESSENTIAL JOB FUNCTIONS 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. EDUCATION Completion of up to 18 months’ additional business education beyond high school. EXPERIENCE Two to three years of related administrative experience in an insurance or managed care setting. Requires 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. PHYSICAL DEMANDS Position requires lifting of 20 pounds maximum, with frequent lifting and/or carrying of items weighing up to 10 pounds. Occasional minor discomforts from continual exposure to video display terminal. Time Type: Full time Seven Counties is the provider of choice for mental and behavior health services in and around the Louisville Metro. Over 1,400 employees work in 25+ locations throughout Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer and Trimble counties; making sure that the 31,000 people we serve annually have the best chance of living their best lives. At Seven Counties, we give our staff the opportunity to do what they do best with continued training, effective mentoring and competitive salaries and benefits. In an effort to protect our employees, clients and community, we require the COVID and Influenza vaccinations for all employees.

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.
Requires 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.