UTILIZATION/BILLING ASSISTANT

Job Description

 

Position Overview

 

Reporting to the Utilization Review Director, assisting in authorization and approval for all clients requiring pre-authorization and continued stay review for all levels of care. Contacts managed care organizations to provide clinical information. Reviews individual charts on each unit as to ensure proper utilization of services.

 

Tasks and Responsibilities

 

  • Assist in facility-wide utilization management activities.

  • Perform pre-authorization function to gain approval for facility admissions.

  • Communicate verbally, or by other means, with managed care organizations and other insurance providers to gain approval for continued stay.

  • Communicate with physicians, physician advisors, and other members of the medical or clinical staff, as necessary, to accomplish timely review of clients as needed to ensure appropriate admissions and length of stay.

  • Maintain a systematical method of documentation for all interactions with coverage providers, as well as a follow-up system to ensure reviews are conducted, as required.

  • Write such reports as pre-authorization log and report, and length of stay reports, as well as correspondence to managed care and other coverage providers.

  • Identify patterns of overutilization and under-utilization of resources.

  • Complete and Submit billing on a timely basis.

  • Report suspected problems for review by the Performance Improvement Committee.

  • Attend treatment team meetings and provide input as appropriate to the case. Attends daily meetings to update the status of each case.

  • Prepare pre-authorization and other reports. Completes annual report and evaluation of the UR Program.

  • Coordinate the continuum of care for clients discharging from inpatient level of care to areas serviced by Minerva Park Behavioral Health or alternate agencies.

  • Notify the supervisor of any unexpected changes to a case.

  • Attend all in-service training and participate in other educational activities, as required.

  • Other tasks as assigned. *

 

Requirements and Qualifications

  • Minimum of 1 year experience working with chemically dependent individuals.

  • Must be proficient in Excel.

  • Excellent interpersonal skills with clients, colleagues, and community resources.

  • Excellent time management skills; organized and able to prioritize.

  • Comfortable in a fast-paced environment with multiple clients

  • Able to organize and manage large amounts of files, schedules, dates, and information.

  • Calm and cool-headed with a positive attitude

  • Self-directed and self-motivated

  • Comfortable with building personal relationships and dedicated to helping others.

  • Fulfill documentation requirements of the position accurately and in a timely manner.

  • Use inclusive, culturally appropriate language and attitudes with all residents and staff.

  • Continue to develop professional skill by maintaining certification through required coursework.

  • Maintain confidentiality of client inform

 

Skills

Critical thinking – Using logic and reasoning to identify the strengths and weakness of alternative solutions, conclusions or approaches to problems.

Speaking – Talking to others to convey information effectively.

Active Listening – Giving full attention to what other people are saying, taking time to understand the point being made, asking questions as appropriate, and not interrupting at inappropriate times.

Reading Comprehension – Understanding written sentences and paragraphs to work related documents.

Social Perceptiveness – Being aware of others’ reactions and understanding why they react as they do.

Service Orientation – Actively looking for ways to help people.

 

Abilities

Problem Sensitivity – The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.

Inductive Reasoning – The ability to combine pieces of information to form general rules or conclusions (Including finding a relationship among seemingly unrelated events).

Written Comprehension – The ability to read and understand information and ideas presented in writing.

Oral Expression – The ability to communicate information and ideas in speaking so others will understand.

Oral Comprehension – The ability to list and understand information and ideas presented through spoken words and sentences.

Speech Clarity – The ability to speak clearly so others can understand you.

Licensure and Certification Requirement

CDCA or higher preferred

*This position description in no manner states or implies that these are the only duties and responsibilities to be performed by the employee filling this position, who will be required to follow instructions and perform any duties required by the employee’s supervisor or designee.

 

Job Type: Full-time

Pay: $16.00 - $18.00 per hour

 

Benefits

  • Dental insurance

  • Health insurance

  • Life insurance

  • Paid time off

  • Vision insurance

 

Schedule

  • Monday to Friday

 

Work Location: One location

Upload Resume
Thanks for submitting!