General Statement of Duties:

The incumbent will participate with the agency’s efforts to maximize managed care reimbursements by providing support to the Authorizations and Benefits Specialist position with the duties of pre-audit activities related to the authorization process and proactively obtaining new and continued authorizations. As well as tracking and assisting in the reauthorization process, and maintaining up-to-date information on payer requirements. Incumbent will develop and maintain a knowledge base of various insurance and managed care contracts and related credentialing requirements and will foster positive communications with managed care representatives.

The incumbent may interact with clients and/or their families related to the managed care authorization process. The incumbent will work collaboratively with administrative, reimbursement, and clinical staff on the overall goal of maximizing agency revenue.

This position is supervised by the Compliance Supervisor.

This position is classified as non-exempt under the Fair Labor Standard Act.

Distinguishing Features of Work:

The incumbent performs under minimal day-to-day supervision a range of technical responsibilities requiring independent judgment, the application of information management techniques, and the ability to organize and prioritize time sensitive tasks. The incumbent must have excellent verbal communication skills and also be able to communicate effectively in writing. The incumbent will positively contribute to the agency’s culture of Respect, Integrity, and Good Humor and Hope. The incumbent will actively strive for effective working relationships with co-workers, clients, family members and other stakeholders and embraces the agency’s mission and makes positive contributions toward its success.

Major Duties and Requirements:

Supports the Authorizations and Benefits Specialist position in reviewing Credible Notifications to identify individuals with a payer source requiring pre-authorization or other special management/documentation/etc.;

Support the Authorizations and Benefits Specialist position in pre-audit activities related to assuring clients’ medical records have the minimum clinical documentation to support the authorization request;

Assists with obtaining managed care authorizations within required time frames and communicate necessary information to reimbursement and clinical staff;

Tracks and/or obtains ongoing authorizations for specific staff members or program areas

Tracks Client Medicaid insurance eligibility status on a monthly basis and provides clinical and reimbursement staff of any changes

Maintains current knowledge of insurance companies and other payers to ensure up-to-date information

regarding requirements for maximum reimbursement for CSB services provided;

Maintains current knowledge of CSB clinical staff, their respective credentials, and their status as approved providers with each payer source.

Conveys information for accurate tracking of authorizations through use of the electronic health record notifications and reports

Works closely with Billing personnel in Finance Department to maximize collections and improve processes.

Responsible for open and positive communication with managed care representatives and with clinical and reimbursement staff involved in managed care;

Provide weekend coverage on a rotational and as needed basis for required Serious Incident Reporting and Authorizations with other Compliance staff members.

Monitors managed care re-authorization process in specific areas of responsibility;

Provide assistance with the development and maintenance of electronic health record forms and templates;

Provide assistance with other data and information tasks as assigned;

Participate as interest and need is relevant in limited off-hour coverage for required regulatory reporting and authorization;

Maintains and assures effective relationships with coworkers and customers based on courtesy, compassion and respect;

Performs duties in accordance with CSB policies and procedures, and performs other duties as assigned.

Required Knowledge, Skills and Abilities:

The incumbent possesses knowledge of the principles and practices of managed care.  Possesses knowledge of behavioral health services, medical necessity, levels of care, and requisite record keeping and documentation. Ability to collect information on third-party payer(s) regarding benefits, reimbursement requirements and authorization procedures. Strong computer and data management skills, plus excellent attention to detail(s). Ability to organize and manage multiple tasks simultaneously and the ability to coordinate responsibilities with the work of others. Excellent communication skills and the ability to articulate technical details in an understandable manner to others within both written and verbal modalities; excellent judgment; dependability; efficiency; and confidentiality.

Minimum Education and Experience:

Graduation from an accredited college or university with a bachelor’s degree in human services, business, public administration or a related area; some experience working with managed care and/or behavioral healthcare, or, any equivalent combination of experience and training which provides the required knowledge, skills and abilities.

Other Information:

Equipment: Telephone, computer, fax, copier.

Work Environment: Behavioral healthcare setting with routine office lighting levels, temperature ranges, air quality, ventilation, and noise levels.

Work Location: 1241 North Main Street, Harrisonburg, Virginia.

Work Hazards: Minimal hazards associated with general day-to-day behavioral healthcare operations; occasional hazards associated with problem behaviors.

Work Schedule: Full-time, Monday through Friday, regular office hours. Schedule is set and may be adjusted by the Compliance Supervisor in consideration of factors that will maximize the effectiveness of this position. If scheduled, some evening, weekend, or additional hours may be required on occasion to perform job requirements. Regular attendance is required.