Billing Specialist and Utilization Review for Recovery Clients

Samaritan Recovery Community•Nashville, TN

18d•Onsite

About The Position

The Utilization Review and Support Specialist works collaboratively with Leadership and agency departments to conduct insurance precertification and concurrent reviews, manage insurance billing, compile monthly reports, complete state billing through TNWITS, and audit client electronic and paper records. The role maintains client and program records according to agency standards, collects data and prepares statistical reports, provides support to clinical and admissions staff, and performs other related duties as assigned. This is a full-time, non-exempt position located in Nashville, Tennessee. The employer may change or assign other duties to the position.

Requirements

At least two years of college or an associate degree in a human service-related field, or eligibility for LADAC.
At least two years of experience working in substance abuse treatment admissions or medical records.
Demonstrated experience conducting insurance precertification and continued-stay reviews, client assessments, and billing.

Responsibilities

Verify client insurance coverage and benefits.
Work with agency departments and use ASAM criteria to complete timely precertification and continued-stay reviews for residential and intensive outpatient programs.
Communicate precertification and review information to clinical and admissions staff.
Submit insurance billing information to managed care organizations and monitor payments and denials.
Submit required documentation to managed care organizations, including PINs, discharge summaries, and release of information forms.
Assist the clinical team with scheduling required TnCare discharge appointments as needed.
Attend TnCare and third-party payer meetings, keep informed about insurance industry changes, and report updates to the Director.
Manage and conduct state billing in the TNWITS system.
Batch and enter TNWITS encounters weekly.
Balance the SRC database to TNWITS monthly, submit invoices to the SRC Administrative Assistant, and make corrections as needed.
Conduct Level I record audits in accordance with agency policy and procedure.
Interview clients by telephone for prescreening and assist admissions with scheduling screening appointments.
Prepare Utilization Management and statistical reports related to all programs for the PSO.
Participate in Professional Staff Organization meetings.
Maintain client and program records according to agency standards, collect data, prepare statistical reports, and provide support services to clinical and admissions staff.