Insurance Verification and Placement Specialist

Job ID
2022-7377
Job Locations
US-TN-Brentwood
Posted Date
1 week ago(11/21/2022 5:27 PM)
Category
Administrative/Clerical

Overview

Company Summary

If you are searching for a fulfilling place to develop your career and an opportunity to make a difference in helping others, then keep reading on. Here at AAC, we have a progressive culture; we listen to your ideas, value a work/life balance, invest in education, and we foster trust and respect for all individuals. Our exceptional comp and strong benefits include company matching 401K, medical, dental, vision and life insurance. We are looking for our future leaders, who are not only going to fill the qualifications for this job description, but who are going to exceed expectations. Be a part of a team whose mission is to provide quality, compassionate, and innovative care to adults struggling with addiction and co-occurring mental health disorders. Our purpose and passion are to empower patients, their families, and our communities by helping individuals achieve recovery and optimal wellness of the mind, body, and spirit.

Responsibilities

Job Summary

The Insurance Verification and Placement Specialist works in collaboration with different departments across our community of facilities to obtain necessary billing and case management information prior to admission to verify client benefits to assist in placing clients into the appropriate program.  This role must build effective working relationships with the work group for the benefit of our clients.

 

Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

  • Make outbound calls to insurance companies to ensure eligibility and coverage for new and recurring clients seeking admission into one of our treatment facilities. Maintains composure throughout call, even when difficulties or communication barriers arise during the course of the call
  • Analyze patient eligibility and benefits and review presenting problem (diagnosis) to determine clinical appropriateness using ASAM Criteria and Insurance Medical Necessity Guidelines; documents client benefits and estimates LOC for proper placement decision
  • Inputs data and estimates LOC with accuracy (goal of 95% or better), ensures finished outcome/placement is high-quality, and places accuracy ahead of speed in performing job duties
  • Communicate client benefits and placement information clearly and concisely to Treatment Consultants/Treatment Consultant Managers and clients
  • Perform pre-claims authorization for clients prior to admission
  • Serve as a financial counselor responsible for estimating a client’s financial responsibility based on coverage information obtained
  • Relay necessary information in a concise manner to peers and clients/family members prior to admission
  • Serve as a resource for Treatment Consultants/Treatment Consultant Managers and their clients, Interventionists, and referral partners on matters relating to client insurance questions and out of pocket cost
  • Follow detailed processes and procedures as set forth by department managers to ensure a safe and accurate admission
  • Communicates effectively and concisely with both peers and individuals outside the organization; clarifies purpose and importance of topic, stresses major points, and communication follows a logical sequence. Asks well-prepared, thoughtful questions, and effectively builds trust and open communication. Able to speak persuasively, convincingly, and reassuringly when needed to facilitate open communication.
  • Applies knowledge of technical tools and healthcare methodologies to daily tasks, and serves as a source of institutional/industry knowledge to others.
  • Committed to ongoing learning; keeps abreast of latest healthcare rules and regulations relevant to job role
  • Perform day-to-day responsibilities with little supervision
  • Able to perform in a team environment; shares important and/or relevant information with peers, adheres to team expectations and guidelines to fulfill team responsibilities, and assumes new responsibilities when the opportunity arises
  • Consistently looks for ways to improve personal performance as well as process improvement for the team; accepts/acts upon constructive criticism and feedback from clients, Treatment Consultants/Treatment Consultant Managers, peers, and supervisors

Qualifications

Education/Experience:

  • High School Diploma or GED equivalent (bachelor’s degree preferable)
  • 2 – 5 years hospital verification and/or utilization review experience
  • Knowledge of managed health care and commercial plan
  • Knowledge of medical terminology; knowledge of behavioral health terminology preferred
  • Prior call center experience; prior experience in a patient-care setting and/or insurance verification environment preferred
  • Understanding of medical criteria
  • Prior case management pre-certification preferred in addition to verification
  • Excellent communication skills
  • Basic PC skills and Microsoft office skills (Internet explorer, Word, Excel, PowerPoint)
  • Salesforce experience preferred
  • Experience with online tools such as Emdeon, Navinet and Availity

Physical Requirements

AAC is committed to principles of equal opportunities for all employees.  The Company will provide reasonable accommodations that are necessary to comply with State and Federal disability discrimination laws

  • Prolonged sitting at a desk
  • Must be able to lift 15 pounds at a time

American Addiction Centers is an equal opportunity employer.  American Addiction Centers prohibits employment practices that discriminate against individuals or groups of employees on the basis of age, color disability, national origin, race, religion, sex, sexual orientation, pregnancy, veteran or military status, genetic information or any other category deemed protected by state and/or federal law.

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