Nuvance Health Careers

Description

• The Leapfrog Group - Grade A for quality and patient safety
• U.S. News & World Report - High performance in heart failure treatment
• Healthgrades - One of America’s 50 Best Hospitals
• Surgical Review Corporation (SRC) - Robotic Center of Excellence
• Joint Commission - Gold seal of approval in spine surgery

Summary:

Under the direction of the Manager, the Behavioral Health (BH) Financial Services Administrator plays a crucial role in supporting the Crisis Intervention team by managing patient financial services and reimbursement processes. This includes obtaining proper documentation in the patients� chart justifying the need for treatment, obtaining insurance prior authorizations for psychiatric hospitalizations, coordinating and submitting claims appeals, and overseeing the retro review and appeals process to prevent denials and revenue loss. The Administrator works closely with insurance providers, hospital staff, and patients to ensure timely and accurate financial approvals, ultimately facilitating access to critical mental health services while optimizing reimbursement outcomes.

Responsibilities:

1. Denial Management-Focuses on preventing claim denials by verifying accuracy, resolving issues, and collaborating with payors and internal teams for timely reimbursement. Tracks trends and recommends process improvements
2. Insurance Verification: Confirms patient insurance eligibility, processes payor requirements, and secures billing details through online portals or direct communication.
3. Authorization & Pre-Certification: Initiates and obtains prior authorizations, pre-certifications, and referrals using the EMR system to ensure compliance with payor policies.
4. Clerical & Documentation:
5. Maintains accurate records, processes necessary correspondence, and updates patient insurance coverage for billing efficiency.
6. Team Collaboration: Coordinates with clinical and administrative staff to ensure accurate and timely submission of patient information to payors.
7. Training & Support- Educate clinical/support staff on financial processes and insurance portals and maintain reimbursement continuity.
8. Appeals and Denials- Works directly with the finance team to complete retro-authorizations, appeals, and denials in a timely and efficient manner to obtain and recover revenue.
9. Meetings-Actively participates in daily safety huddles, inpatient psychiatric touchpoint, and weekly longer length of stay meetings in an effort to reduce and eliminate revenue loss from denials.
10. Compliance & Other Duties- Ensures adherence to regulatory requirements and performs additional tasks as assigned.
11. Maintains and Models Nuvance Health Values.
12. Demonstrates regular, reliable, and predictable attendance.
13. Performs other duties as required.

Other Information:

Position requires knowledge of all aspects of responsibilities of the CBO; Basic knowledge of applicable federal, state laws and regulations; well-developed verbal and written communication skills; Excellent analytical and problem solving skills; Strong working knowledge of payor rules and regulations; Knowledge of hospital billing; Demonstrated ability to manage multiple and complex tasks; Demonstrated ability to train and motivate employees; Professional attitude and ability to relate to executive management and patients; Exhibits self-direction, good judgment in handling difficult situations and good organization, time management, interpersonal and conflict resolution skills.

Bachelor's degree preferred. Minimum Experience: three years

Company: Nuvance Health Med Practice CT

Org Unit: 504

Department: DH Inpatient Psych

Exempt: No

Salary Range: $21.49 - $41.73 Hourly