Insurance specialist/admission coordinator

Company Name:
System One Holdings, LLC
This
position
will be required to carry out the duties of both an Insurance Specialist and also as Admission Co-coordinator. This position involves screening clients who need admissions in our various treatment programs nationwide.
Duties:
Validating cash only admissions
Charge credit cards for clients total OOP cost
Track schedule incoming flights to our programs
Follow up on pending cash due
Create invoice/financial agreements for clients,
Monitor & report cash collected and VOB trends
Oversee bed count in the evening
Create and maintain reports (I.E. KPI, AMA, Quality lead Etc...) on all admissions.
Data integrity monitoring
Making outbound calls to insurance companies to ensure eligibility and coverage for new and recurrent patients looking for admissions into our treatment.
Verifying eligibility and benefits after hours using online portal to determine coverage.
Evaluating patients benefits and reviewing their presenting problems (diagnosis) to determine clinical appropriateness (Using ASAM criteria & Ins. Medical necessity Guidelines)
Work in collaboration with different departments across our
community
of facilities nationwide, to help facility smooth admission process
Ability to relay necessary information in a concise manner to, management, peers, clients and their family members post admission
Serve as a resource for TC (Treatment Consultant) managers, TC's and their clients; referral partners on financial matters as it relate to client out of pocket cost.
Build effective working relationships with fellow work group members for the good of our clients
Must have the ability to follow detail process and procedures to ensure a safe and accurate admission set forth by the Department Managers
Other duties as assigned by Department Directors
Requirements:
2 - 5 years Administrative experience in hospital setting
Bachelor Degree preferred
Knowledge of managed health care and commercial plan
Knowledge of medical terminology
Knowledge of behavioral health terminology a PLUS
Working knowledge of UR management a PLUS
Excellent communication and writing skills
Microsoft office skills (Internet explorer, Word, Excel, PowerPoint)
Prior experience with CRM and EHR a MUST
Customer Relations Experience
Prior Call Center experience required
Excellent benefits and visibility in a growing company
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