Managed Care Specialist (BHS) - York - Days

York, PA | Clerical and Administrative | Tracking Code: 66035

Job Description:

Under the general supervision of the Practice Manager, 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

  1. Secures information relative to patient's financial status or insurance coverage. May complete insurance forms, verify insurance coverage, and secure other information if needed.
  2. Accurately identifies behavioral health payer per medical plan. Acts a resource to practice staff and providers in this area.
  3. 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.
  4. 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.
  5. Counsels patients requiring external financial assistance, including recommending third parties.
  6. Refers adults and children to System resources for completion of applications for medical assistance.
  7. Serves as information resource to patients and System staff regarding credit and collection policies, procedures, and payment assistance options.
  8. Answers inquiries from patients, doctors' offices or third party payers and follows through to resolution.
  9. Interprets and explains to patients and their families the charges, services and policies regarding payment of bills.
  10. Initiates paperwork for refund of overpayment to patients, guarantor or third party payers after researching to verify credit balance is correct.
  11. Performs various functions to complete and expedite the billing process including, but not limited to, recording patient
  12. identification data and physician diagnosis, investigating charges, correcting and updating data, preparing the claim to bill,
  13. and updating computer functions.
  14. Resolves billing problems and/or receives insurance updates.
  15. Processes rejections and invoice corrections.
 

Qualifications

  • Minimum Experience:
    • 1 - 2 years (Insurance Billing experience)
  • Minimum Education:
    • High School or G.E.D.
  • Preferred Courses:
    • Medical terminology
  • Skills:
    • Excellent interpersonal/communications skills
    • ICD9 & CPT coding; insurance knowledge;
    • Computer skills
    • Customer service skills preferred
    • Able to work independently
Michelle Dermes
Michelle Dermes
Sr. Talent Acquisition Consultant
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Why WellSpan Health?

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization comprises a multispecialty medical group of more than 1,600 physicians and advanced practice providers, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 20,000 employees and 200 patient care locations. WellSpan is a charitable, mission-driven organization committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Employment Benefits

  • Sign-on incentives for new employees (click here for details)
  • Medical, dental and vision insurance
  • Life and accidental death insurance
  • Supplemental life insurance
  • Retirement savings plan
  • Paid time off (PTO)
  • PTO bridging
  • Short-term disability
  • Educational assistance
  • Forgivable loan
  • Flexible spending
  • Credit union
  • Employee recreational activities
  • Childcare
  • Complimentary medicine discounts

Diversity & Inclusion

Welcome. Respect. Value.

Wellspan Health believes that diversity includes all the human characteristics that make each of us similar as well as different. We strive to make every person feel welcomed, respected, and valued while creating a safe and inclusive environment where we all have the individual freedom to express our uniqueness in a respectful manner.

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)