Description

• Limitless growth and career advancement opportunities
• Career development offered internally through our Organizational Development & Learning Department
• Generous PTO program – up to 3 weeks off your first year with continued accruals each pay period.
• 9 paid holidays per year
• Wellness Program - Offering access to an expert Health Coach and wellness incentives to lower cost.
• Tuition reimbursement assistance up to $3,000
• Affordable health care plans: Medical, Vision, and Dental
• H.S.A., H.R.A, F.S.A. (with select medical plans)
• Free Short-Term Disability and Life/AD&D Insurance up to $100,000
• 403(b) retirement plans with company match.
• Employee Assistance Program Voluntary benefits: Long-Term Disability, Pet Insurance, Additional Life/AD&D Insurance, and much more!

• Adheres to all HIPAA privacy and confidentiality regulations and guidelines.
• Establishes rapport and credibility with members and payors by providing excellent customer service in a professional and ethical manner.
• Confirms, and updates as needed, insurance and patient demographic information in the EHR.
• Collects, verifies, and shares necessary information with member’s payor to procure benefits and eligibility information.
• Obtains pre-authorization and/or confirms eligibility of services for all new members and uploads information into the EHR.
• Processes eligibility case files within the required timeframes established by the identified funding source.
• Completes eligibility screening process in electronic health record.
• Communicates across departments the status of members’ eligibility.
• Maintains billing rules of members in the EHR.
• Provides feedback to interdisciplinary team about medical necessity criteria and ongoing utilization reviews.
• Tracks expiration of residential authorizations to ensure all members have active authorizations.
• Manages authorization denials, including scheduling peer to peer reviews.
• Collaborates with treatment providers to secure timely submission of concurrent authorization reviews.
• Submits concurrent authorization reviews directly to the payor.
• Utilizes web-based verification systems and reviews real time eligibility responses to ensure accuracy of insurance eligibility at time of appointment.
• Initiates the change in payor process anytime a member’s funding source changes.
• Performs quality checks in the EHR to ensure all information is accurate to minimize clerical errors.
• May aid members in completing applications for Medicaid, Medicare, SSI/SSDI.
• Completes miscellaneous tasks assigned by supervisor(s).
• Supports the office assistant during high volume times by performing administrative tasks such as copying, faxing, scheduling, and answering telephone calls.

• Establishes and maintains general understanding of services offered.
• Displays an understanding of current Medicaid/Medicare/Marketplace information and systems.
• Ensures the maintenance of departmental operations to achieve compliance with grant requirements, contract requirements, federal/state/local regulations and all other licensing/regulatory agencies as directed.
• Adheres to compliance with agency procedures and licensing and accreditation standards related to health and safety..
• Demonstrates superior work habits including, but not limited to: time management, taking initiative, role modeling, leadership, organization, multitasking, and written and oral communication skills.
• Employment is contingent upon successfully passing an employee reference check, criminal background check, drug screening, and confirmation of qualifications.