Dc Operations Manager Jobs in Racine, WI (NOW HIRING)

Our next Intake Specialist will be responsible for the client registration and intake process, which includes obtaining and entering demographic information, sending requests for client information and consents via EHR and/or Adobe Pro DC, and verifying insurance eligibility, benefits, network status, and completing intake screen and screeners for clients served in an outpatient clinic setting. This position will also be responsible for prior authorization submission and follow-up on eligibility or billing issues for current clients.

Qualifications:

• Bachelor's degree in psychology, social work or related field required.
• Master's degree in psychology, social work, or related field preferred.
• A minimum of 3 years' experience working with an electronic health record (EHR) system with data entry experience required. EPIC experience preferred.
• A minimum of 3 years' experience required of medical/mental health office experience with working knowledge of Medicaid, Medicare and Commercial health plans and must understand, be able to convey to clients, and call insurance plans about insurance eligibility, benefits and network status to include but not limited to copay, coinsurance, deductible, out-of-pocket maximum, in-network, out-of-network, EAP, Prior Authorizations, Single Case Agreements, etc.
• Experience performing clinic operational tasks such as creating and organizing workflows, monitoring clinic staff coverage, and some billing functions.
• Must have a working knowledge of the International Classification of Diseases (ICD-9-CM, ICD-10-CM), current Procedural Terminology (CPT-4) coding.
• Proficient in the usage of computer software; demonstrate an understanding of computer file systems and computer software packages, e.g., Microsoft Office 365 suite of products, Excel, Word, Outlook, OneNote, Adobe Pro DC tools, EPIC or other EHRs
• Physical exam, drug screen, motor vehicle report, and background checks are required for this position.
• A valid Wisconsin Driver's License Required or reliable transportation to attend on-site meetings, events, and/or learning throughout the state.

Duties:

Intake and Insurance

• Tracks, maintains, confirms, and secures referrals and contributes to obtaining information needed to accept referrals.
• Schedules new client appointments and transportation, as necessary.
• Performs registration responsibilities; obtain, enter, and update demographic information; send requests for client information and consents via EHR and/or Adobe Pro DC; and verifies insurance eligibility, benefits, and network status.
• Completes screeners (PHQ-9, GAD, CSSR) and other screeners as appropriate.
• Ensures accurate client information is entered and necessary insurance and referral documents are uploaded into electronic health record
• Ensures medical record documents are scanned into HER in a timely manner.
• Communicates with clients via phone or mail to obtain additional insurance information and interacts with departments/clinics to resolve charging issues affecting the claims.
• Completes client risk assessment and crisis triage for all new referrals, provides resources for immediate support, and connects to clinical team if identified high risk.
• Manages client information tracking on Clinic Caseload Excel spreadsheet with a working knowledge of provider licensing types to include maintaining and modifying data, rows/columns, worksheets, and workbook.
• Obtains vitals for medication management clients.
• Maintains confidentiality and adheres to all HIPAA requirements.

Client Service Coordination

• Registers clients, supports completion of all necessary forms, confirms and updates demographic and insurance information.
• Explains outstanding balances and payment obligations to clients at the time of their service, collects and posts payments.
• Ensures phone calls are answered timely to ensure excellent customer service.
• Responds to urgent in-person and phone requests, screening for suicidality, and triaging patient needs appropriately.
• Addresses crisis situations utilizing de-escalation, and trauma informed care techniques, and navigating individuals through the appropriate crisis intervention protocol.
• Provides support to patients with requests via phone, email, and or portal with payment/billing related questions, scheduling needs, release requests, miscellaneous inquires, etc.
• Supports patients with telehealth access, Patient Portal issues, and other technology-related troubleshooting as needed. · Offers various assistance to clients including arranging transportation needs, providing directions, providing bus passes, etc.
• Reviews incoming requests for information or support and distributes to appropriate team members.

Program Coordination

• Provides general clinician support by assisting clinicians with administrative questions and/or duties such as sending letters, faxes, etc.
• Acts as a liaison between Wellpoint Care programs by facilitating completion of paperwork, following up on internal referrals, and being a primary contact point for CFWB and CCS families.

Billing and Payment

• Utilizes knowledge of CPT and ICD-10 codes, billing modifiers, and billing rules in accounts receivables processing as needed
• Investigates and resolves EHR billing task issues; review codes, modifiers, eligibility and utilize high level problem-solving skills to resolve.
• Monitors Medication Management intakes, insurance coverage, appointments, orders, and requests from psychiatrist.
• Maintains knowledge of Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans and procedures requiring prior authorization and current accepted insurance plans.

Prior Authorizations

• Creates and submits Prior Authorizations for psychotherapy, in-home therapy, occupational therapy services as required by insurance type.
• Maintains database and routinely follows up on prior authorizations, EAP authorizations, single case agreements, sliding scale approvals, Self-pay, and out of network cases.
• Notifies therapists in advance of due dates and serves as a resource to staff to facilitate timely completion.
• Processes Records requests with assistance of Clinic Manager and QA/QI Director
• Provides the highest level of client customer service by problem solving, documenting patient concerns and contact, and identifying appropriate follow-up.
• Educates clients regarding referral and authorization requirements, payer coverage, eligibility guidelines, and insurance related changes and clinic financial options.

Agency Engagement

• All employees will be evaluated on their demonstration of a consistent commitment to the Agency's Seven Essential Ingredients and engagement in the strategic initiatives of the organization. This will be measured by their active participation in committees and workgroups, and by their communication and practice within their daily work and in the community.
• Participates in assigned meetings, events and learning as required.
• Other duties as assigned including serving in a coverage role for other department members.
• Exhibits professionalism in all aspects of practice adhering to the Agency's code of conduct and expectations, policies, and safety standards
• Works in partnership with the Campus Service Manager and Guest Service Representatives.
• Coordinating with the GSRs on client transportation needs.
• Serves as an active, participating member of the Safety Committee representing the Mental Health group.

Position Details & Extras:

• Full time.
• Moderate exposure to noise.
• May require travel to attend meetings and events.
• Subject to frequent interruptions with ability to handle multiple tasks simultaneously.

Organizational Information:

At Wellpoint Care Network, we have seen exactly how trauma, poverty, systemic racism, social injustices, and other barriers create instability in all areas of life. The people in our care face education and health disparities, high unemployment rates, and unaffordable housing. What's worse, many have lost connections to resources, family, friends, and other support systems. We have seen the toll it has on a person's physical, emotional, and financial well-being to try and successfully navigate complex systems that may have failed them in the past.

We believe there is a better way. So, we have anchored ourselves in our 170 years of caring for our neighbors through modernized human services.

Wellpoint Care Network provides a rich continuum of services, including:

• Child Welfare and Foster Care
• Support for youth who have aged out of care