insurance Verification Coordinator
New Season

For over 30 years, New Season Treatment Centers have been a leading national health care service provider of outpatient treatment centers that specialize in providing safe, quality and best in class care for individuals living with Opioid Use Disorder ("OUD").

Operating in over 70 treatment centers in multiple states, our team members are engaged in medication-assisted treatment, counseling, support, and care management of individuals living with OUD. We treat the whole person and, in so doing, address the underlying causes of OUD in an effort to provide a continuum of care that not only addresses treatment needs but supports the patient on their journey to recovery.

Insurance Verification Coordinator 1

Job Description

New Season

Reports to: Director of Patients Accounts

Job Code: 313

Department: Revenue Cycle

FLSA: Non-Exempt

Direct Reports: 0

Job Summary:

This position obtains and verifies patient's insurance that will better benefit the patient. This will include conducting prior authorization process, copay assistance, and coordination of benefits.

Essential Functions:

• Manages all activities related to the intake, referral management, and insurance verification functions, including implementation of initiatives for third party.
• Develop indicators for monitoring and evaluating quality of work and meeting turnaround time standards.
• Establishes work directions, resolve problems, and set performance expectations and deadlines to ensure timely completion of all department deliverables.
• Writes practices State and Payer specific and implement changes ensuring compliance with all related laws, regulations, and contractual requirements.
• Ensures all deadlines related to referral processing and turnaround times for the assigned programs are met.
• Ensures up to date quality control processes to ensure the integrity of enrollment and insurance verification data.
• Develops and ensures a consistent work process is followed around new patient admission tracking in conjunction with the operations team.
• Evaluates the effectiveness of the intake and related program activities ensuring consistency of work processes and recommend changes.
• Identifies utilization trends of incomplete or inaccurate verification processes and develop appropriate work processes to respond to exceptions and minimize financial risk.
• Ensures accurate, timely, and efficient reporting for intake core processes.
• Recognizes invalid/incorrect rejections and be able to follow through with insurance companies in obtaining the correct response.
• Must have an understanding of commercial insurance benefits verification.
• Has knowledge of Medicaid Plans.
• Able to manipulate the Coordination Of Benefits for secondary payers.
• Responsible for loading insurance plans; primary and secondary if necessary.
• Ability to negotiate a Letter Of Agreement or an Assignment Of Benefits with the insurance plan in coordination with the Revenue Cycle Director.
• Ability to multi-task/fast-paced follow-ups.
• Runs Eligibility Checks for all patients.
• Monitor the authorization process to assure the authorizations are obtained in a timely manner.
• Complete and initiate prior authorizations.
• Maintains billing episode changes and/ or similar account maintenance when health plan information is added, deleted, or modified for claims that are rebilled.
• Build relationships with Managed Care Organization / Behavioral Health Organizations and referral sources.
• Keep open lines of communication with the Clinic Operation Team Ensures individualized goals are met.
• Adheres to the service policy and principles of CMG / New Seasons.
• Other duties as assigned.

Supervisory Responsibilities:

(This position will supervise non-exempt staff in support roles performing duties described in "Essential Functions".)

None

Essential Qualifications:

(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the competencies (minimum knowledge, skill, and ability) required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions).

Education/Licensure/Certification:

This position requires a High School Diploma or GED.

Required Knowledge:

The candidate must be computer literate and have knowledge of all Microsoft products, especially Microsoft Outlook and Office, Google Suite, as well as Call Center hardware and software. Must know Commercial insurance plans and Medicaid HMO's, Current procedural terminology and ICD-10 Dx Codes.

Experience Required:

This position requires 2 years of previous healthcare or customer service experience.

Skill and Ability:

The candidate must possess excellent interpersonal and verbal communication skills, be able to multitask, prioritize, and be dependable, reliable, and flexible.

Physical Demands/Work Environment:

(The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

Finger Dexterity:

Use primarily for writing, operating calculator, telephone, keyboard, and other office equipment.

Talking:

To convey detailed or important instructions to employees, patients, and applicants.

Hearing:

Ability to hear normal conversations and receive ordinary information.

Vision:

Average, ordinary, visual acuity necessary to observe patients and work on computers. Clear vision at 20 inches or less and distant vision at 20 feet or more.

Physical Strength:

Sedentary work; sitting most of the time. Exerts up to 10 pounds of force occasionally.

Working Conditions:

(The working conditions described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

• Ability to perform other duties as required.

Core Competencies:

➢Analytical thinking

➢Computer competency

➢Conflict resolution

➢Decision making

➢Communication

➢Logical reasoning

Mental Activities:

(The mental activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

Reasoning Ability:

Ability to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Ability to maintain confidentiality.

Mathematics Ability:

Basic mathematics (including statistics) skills required.

Language Ability:

Be able to communicate fluently in English, second language proficiency helpful.