Residential Authorization and Insurance Specialist

CHNK Behavioral Health

Residential Authorization and Insurance Specialist

Location:Devou Park

Department:  Billing Services 

Position Reports to:Director of Billing Services         

Position Supervises:   n/a                       

Profile Last Updated: April 24, 2024

QUALIFICATIONS

• Minimum of 2 years' experience as an authorization/utilization review specialist, within adolescent substance use and/or behavioral health facilities.
• Familiarity with residential behavioral health services.
• Experience with CareLogic electronic health record system preferred.
• Experience in billing and coding is preferred but not required.
• Demonstrated history of successfully building relationships with insurance companies, their representatives, and case managers.
• Demonstrated history of receiving approval for optimal days at the highest and most appropriate level of care.
• Self-motivated and able to prioritize and identify processes that need to be implemented and/or improved, and tasks that need completion.
• Above-average organizational and time management skills, with great attention to detail.
• Strong verbal and written communication skills.
• Alignment with the Sanctuary Institute’s trauma informed care model and the Human Rights Campaign’s All Children All Families initiative in LGBTQ+ competencies. CHNK is certified in both models.
• Demonstrated proven sensitivity to the various cultural and socioeconomic characteristics of the CHNK clients and staff.
• Valid drivers’ license or other ability to travel between CHNK sites in a timely manner required.
  
  

POSITION SUMMARY
The Authorization and Utilization Specialist is responsible for the authorization and utilization process for the CHNK Behavioral Health residential services programs. Responsibilities include upload of appropriate documentation into the CareLogic EHR system, verification of required insurance coverage, verification of client eligibility as required, providing cost estimates for clients, running authorization due reports, and managing the extension of upcoming authorizations, working with residential staff and management for timely completion of documentation, and contacting insurance companies when necessary.

ESSENTIAL JOB FUNCTIONS

1. Input and upload insurance information into the EHR and verify insurance coverage/benefits and coordinate primary and secondary benefits at admission and weekly.
2. Complete prior authorization required by the insurance company before the patient can be admitted.
3. Perform as a subject matter expert in reading, understanding, interpreting VOBs (verification of benefits) to advise the team on policies that will not pay enough to cover the daily operation cost per patient. Provide insurance coverage breakdown of costs, including co-payments, co-insurance, and services needing pre-authorization.
4. Track all concurrent reviews to ensure proper documentation is present to advocate for the client to receive the number of days at the highest level of care/most appropriate level of care.
5. Provide feedback to the clinical team on each client's insurance case manager, documentation they want on the next review, and specific language/jargon that will help the client receive the level of care indicated.
6. Provide back up support to Director of Admissions for authorization and utilization reviews.
7. Participate in agency Performance Quality Improvement and Quality Assurance Committee activities.
8. Must be able to perform the essential functions of this position with or without reasonable accommodation.
9. Attend trainings as required.
   
   

BENEFITS

Our full-time associates are eligible for the following benefits to support them as they help us improve the lives of others.
*Thirty-seven paid days off
    13 Paid Holidays
    18 days of PTO   6 additional days of time off for illness of 3 or more days.
*Four weeks of paid family leave (new child or care for a family member) after 1 year of employment
*Student Loan Repayment Assistance up to $10,000 over the course of employment beginning after 6 months of employment
*Tuition Reimbursement of up to $5,000 per year
*Retirement Plan with 6% employer match
*Medical Plan with Zero Deductible 
*Dental, Life, LTD, STD, and Vision
*Flexible Spending Account
*Employee Assistance Program
*Free Parking
*Dog-friendly environment at some locations (bring your pet to work)

CHNK is an Equal Opportunity Employer