Behavioral Health Managed Care Representative

Full-time, Days

80 hrs/2 weeks

7:30am-4pm Monday-Friday

*3-6 month hybrid (remote/on site) training program. Primary training and work area is York PA.

General Summary

Ensures initial and recurrent authorizations are present to ensure timely reimbursement. Assists with coordination of care and/or transfers to higher levels of care. Refers patients to appropriate resources for assistance in completion and submission of applications for public assistance or uncompensated care. Provides support to multiple provider types in behavioral health authorization process. Performs a variety of functions including, but not limited to, account follow up, answering inquiries, resolving problems and interacting with third party payers and/or patients to achieve payment of accounts in accordance with current government and payer regulations. Represents the System in a professional manner using excellent customer service practices in the performance of all duties.

Duties and Responsibilities

Essential Functions:

• Secures information relative to patient's financial status or insurance coverage. May complete insurance forms, verify insurance coverage, and secure other information if needed.
• Accurately identifies behavioral health payer per medical plan. Acts a resource to practice staff and providers in this area.
• Verifies mental health and/or substance abuse benefits, obtains initial authorization as determined by employer's contract with medical plan's individual lines of business.
• Implements tracking system to obtain recertification of services as needed, for psychiatrists, psychologists, licensed clinical social workers and licensed professional counselors. Actively demonstrates knowledge of the difference of process between provider types.
• Counsels patients requiring external financial assistance, including recommending third parties.
• Refers adults and children to System resources for completion of applications for medical assistance.
• Serves as information resource to patients and System staff regarding credit and collection policies, procedures, and payment assistance options.
• Answers inquiries from patients, doctors' offices or third party payers and follows through to resolution.
• Interprets and explains to patients and their families the charges, services and policies regarding payment of bills.
• Initiates paperwork for refund of overpayment to patients, guarantor or third party payers after researching to verify credit balance is correct.
• Performs various functions to complete and expedite the billing process including, but not limited to, recording patient identification data and physician diagnosis, investigating charges, correcting and updating data, preparing the claim to bill, and updating computer functions.
• Resolves billing problems and/or receives insurance updates.
• Processes rejections and invoice corrections.

Common Expectations:

• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Participates in educational programs and inservice meetings.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

• High School Diploma or GED Required

Work Experience:

• 1 year Insurance Billing experience. Required

Courses and Training:

• Medical terminology. Upon Hire Preferred

Knowledge, Skills, and Abilities:

• Excellent interpersonal/communications skills.
• ICD9 & CPT coding.
• Insurance knowledge.
• Computer skills.
• Customer service skills preferred.
• Able to work independently.