Overview

Performs support functions related to successful claim submission, authorizations for continued treatment and denial follow up. Provides insurance companies with information from the medical record to obtain authorizations for treatment in our Outpatient, CPEP, and Inpatient Units. Arranges for Doctor to Doctor calls and other managed care requirements. Assist in the appeals process for denied care or stays.

Responsibilities

• Demonstrates comprehensive knowledge of Managed Care regulations and requirements for authorization.
• Verifies insurances for Inpatients and Outpatients
• Maintains up-to-date notes in EPIC or current EHR
• Promptly reports all issues/problems that impact on the authorization for patient stays/treatment.
• Maintains accurate statistics and completes all outstanding work queue issues.
• Demonstrates excellent verbal communication and customer service skills.
• Contacts Managed Care companies for authorization and continued stay authorizations. Obtains preauthorization and ongoing authorization for continued stay for patients on an Inpatient Unit and in the Outpatient Clinics.
• Provides managed care companies with clinical information as provided by clinical notes and Clinical Staff in order to obtain authorization.
• Attends morning rounds and clinical meetings in order to liaison between clinical team and managed care companies.
• Provides information to MD’s on status of managed care authorizations.
• Enters information and authorizations on hospital medical record system.
• Provides updates to Directors of service and to Coordinators on denials.
• Assist in the process of correcting, rebilling and appealing denials in all areas of the Department including inpatient, outpatient, CPEP, EOB, Linkage and Mobile Crisis.
• Will work with MD’s and Social Workers on all fiscal/insurance issues related to discharge planning.
• Reports to the Billing Manager or his/her designee.
• Performs other duties assigned by the Supervisor.

Qualifications

Education:

• High School Diploma or equivalent.

Experience:

• Minimum one (1) year in working in Licensed Mental Health Program
• Must be computer literate
• Knowledge of medical insurance required
• Knowledge of authorization and denial process
• Knowledge of psychiatric terminology and diagnosis required
• Past experience working with a psychiatric population preferred

Knowledge and Skills:

• Demonstrates comprehensive knowledge of post-hospital resources.
• Ability to fully utilize BHMC’s electronic record systems, equipment and other healthcare and billing systems relevant to this position.
• Demonstrate knowledge of CCM system discharge planning functions and the proficiency and timeliness in data entry.
• Demonstrate excellent verbal communication and customer service skills.

License/Certifications:

• Child Abuse Clearance
• SEL Clearance

Physical Requirements:

• Position requires prolonged periods of standing, reaching, walking throughout the working day. 
• Position will be required to stoop, bend, lift, and carry items weighing up to 15 pounds.

Pay Transparency

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and can be modified in the future. When determining a team member’s base salary and/or rate, several factors may be considered as applicable (e.g., site, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of One Brooklyn Health (OBH).

OBH is an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap or other characteristics protected by applicable federal, state, or local laws.