UM Specialist - Remote open to Louisville Metro applicants only
@ Seven Counties Services, Inc.UM Specialist - Remote open to Louisville Metro applicants only
About the job
This role supports mental health and substance abuse benefit verifications, authorization processing, and communication. Located in Louisville Metro area; ideal for candidates with admin experience and knowledge of managed care.
Requirements
- Observation and analytical skills
- Knowledge of managed care
- Medical terminology knowledge
- Customer service skills
Qualifications
- High school diploma or associate preferred
- Two years administrative experience
Full job description
Job Description:
Consideration will only be given only to candidates living in the Louisville Metro area.
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 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.
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.
EDUCATION
- High School diploma: Associate degree preferred.
EXPERIENCE
- Two years of administrative experience.
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
PHYSICAL DEMANDS
- The position requires lifting up to 20 pounds, with frequent lifting and/or carrying of items weighing up to 10 pounds.
- Occasional minor discomfort from continual exposure to a video display terminal.
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.
Time Type:
Full time