rose hill

Holly , MI

Insurance And Utilization Review Coordinator

rose hill
Holly, MI Full-time
Posted on June 8, 2019

Insurance And Utilization Review Coordinator

Rose Hill Center in Holly Township has an opening for a part-time Insurance and Utilization Review Coordinator.

Responsibilities include: Secure pre-authorizations, and maintain ongoing authorizations, for services from third-party insurance. Gather monthly occupancy data for public pay residents and submit public payer billings through the appropriate portal. Create bills for clinical services for the residents and submit bills to either the family or the insurance company. Troubleshoot third-party claim issues. Manage commercial insurance interface. Manage panel enrollments and compliance with Medicare or other third-party insurance as directed by the management team and board of directors. Coordination with families regarding explanation of their benefits and keeping them apprised of current status of insurance authorizations and appeals process. Coordinate utilization management and review between third-party insurance and the appropriate clinical staff.

Competencies: Ability to identify and solve claims processing issues. Masters various software programs to provide current bills and reports. Adhere to professional standards, company policies and procedures, federal, state, and local requirements, and HIPAA standards. Associates degree and certificate in medical billing, two-years’ related experience in psychiatric third-party billing, ability to pass an FBI background check and drug screen, and possess a valid driver’s license.

We regret that we are unable to acknowledge every resume we receive, and therefore we will contact only those with whom we would like to schedule an interview.