About the Job:

Roles and Responsibilities:

ESSENTIAL FUNCTIONS:

• Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.
• Reviews medical records of clients for appropriateness of level of care at admission and at intervals determined by documentation in medical record.
• Conducts interactive and timely reviews with payers to ensure certification of care.
• Maintains accurate documentation and files as it relates to utilization management.
• Coordinates information and findings with the business office to help recognize or resolve possible payment problems.
• Attends daily treatment team to discuss client needs and ensure that all disciplines are aware of client insurance status and needs.
• Ensure that insurance benefits are verified in a timely manner.
• Communicates any UR or Quality issues as noted in the chart to supervisor immediately to ensure timely resolution of problems.
• Responds to telephone and Internet inquires.
• Researches insurance company guidelines and uses admission and continuing stay criteria for coverage.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• High School Diploma Required, Bachelor’s Degree in social work, alcohol and drug addictions counselor, or other related health field preferred.
• One or more years of direct clinical experience in substance abuse setting and ASAM experience preferred.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

Not applicable.

SUPERVISORY REQUIREMENTS:

This position is an Individual Contributor.

Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.