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200 Powell Place
Brentwood, TN 37027
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Insurance Verification and Placement Specialist
American Addiction Centers • Brentwood, TN
Posted 13 days ago
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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.
Report to: Manager of Assessment and Placement
Training Hours = 8:00am-5:00pm, Monday-Friday for first 6 weeks
Shift Hours = 8:00am - 5:00pm, Monday-Friday with a routing weekend coverage of 8:00am-5:00pm every 4th weekendResponsibilities
- 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
- High School Diploma or GED equivalent (Bachelor 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
- If in personal recovery, a minimum of 2 years clean and sober
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.