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Form of workJob Description
Minimum Qualifications/Requirements:
Preferred Master’s Degree in Psychology, experience with adolescent mental health/co-occurring disorders treatment. Experience in the mental health field related to managing and processing appeals. Peer to peer reviews and provider disputes is important. It is important you are structured and committed to fight for the team for authorization for our clients. Clinical background required (LMFT, CSW or PPC).
Candidate needs to understand IOP/PHP level of care. The candidate also needs to be able to write treatment summaries that illustrates the need for clinical care based on ASAM and CALOCAS criteria.
The person will be asked to complete Utilization reviews with case managers and doctors representing insurance companies.
Reports to: CEO/Owner
General Responsibilities:
Ensure our clinical teams are providing sufficient documentation for the billing company to obtain authorization for treatment. Apply for single case agreements when needed.
Ensure our billing team is collecting on claims. Appealing denied claims with insurance companies when needed and ensure our Utilization review team is completing reviews and peer to peer reviews as needed.
You will keep track and structure all correspondence with insurance companies.
All collection efforts and billing efforts are completed by our billing company in Florida, but you will oversee and direct their efforts. Therefore a solid general understanding of how the process between insurance companies and clients.
SPECIFIC JOB DUTIES:
§ Prepares appeal documentation to submit for internal appeals and independent medical reviews from regulatory departments (e.g. DMHC, DOI, etc.)
§ Participates in multi-disciplinary treatment planning and updates for all clients (helps ensure clear documentation of all treatment modalities/disciplines)
§ Completes admit notes and submits them for treatment authorization; In case of no INN benefits, initiate single case agreement process.
§ Updates treatment team on payment/coverage information to assist with treatment planning processes, including setting ongoing treatment objectives, discharge planning, and facilitation to a lower level of care.
§ Tracks billing reports, insurance payments for services rendered, and collections for outstanding payments.
§ Monitors accuracy and timeliness of financial collections with the billing company.
§ Ensure the team keeps track of authorization and it is documented in the EMR.
§ Participates in in-service training, individual/group supervision meetings, and treatment planning meetings.
§ Tracks billing reports, insurance payments for services rendered, and collections for outstanding payments.
§ Work with our billing company to ensure our In Network contracts are in place and current. Work with the team to apply for new contracts when needed.
Job Type: Part- Time
Salary: $30.00 - $50.00 per hour
Work Location: Van Nuys, CA
Schedule will be 2-3 days in the Van Nuys office
About 15-20 hours a week ideally spread out over 3 days
