Verification Of Benefits Specialist

MISSION STATEMENT: Leading adolescents to a new legacy.

The mission of CLEARFORK ACADEMY is to offer the highest quality and professional, substance abuse and mental health treatment across a full continuum of care.

We are committed to treating patients and their families with the highest regard and respect as clients work toward reaching their highest growth potential in their recovery process. This is accomplished through the strict adherence to the highest ethical standards of care and policies and procedures set forth by the Texas Department of State of Health Services and the Joint Commission.

• CLEARFORK ACADEMY ensures all clients are treated with compassion, respect, and dignity regardless of race, creed, age, sex, handicaps, or sexual orientation.
• CLEARFORK ACADEMY employees are competent and responsible personnel who adhere to a strict code of professional ethics which includes but is not limited to the prohibition of fraternization with patients, exploitation of clients, or any criminal behaviors.
• CLEARFORK ACADEMY provides clients with accurate and complete information regarding the available services including the program rules, regulations, goals and objectives of the program.
• Appropriate availability of alternative treatment modalities is made at any time before, during or after treatment if they are requested or the client’s needs are out of the scope of our practice.
• CLEARFORK ACADEMY will ensure that discharge from treatment is conducted in accordance with Texas rule standards.
• CLEARFORK ACADEMY provides both Texas and Joint Commission environment of care standards.
• CLEARFORK ACADEMY will take all necessary and appropriate measures to maintain individual client records and information in a confidential and professional manner.
• CLEARFORK ACADEMY strives to maintain positive relations with the surrounding community and pursues every reasonable action to encourage responsible client behaviors and community safety.

SUMMARY
The Verification of Benefits Specialist will be responsible for the timely Verification of Benefits for new and existing patients seen by Clearfork Academy. They will be responsible for reading and understanding the patients’ benefits regarding applicable services offered by Clearfork Academy. They will effectively communicate benefits verbally and in writing to perspective and existing patients. They will conduct outbound calls as needed to insurance to ensure the Verification of Benefits is completed and accurate. They will work in collaboration with other departments at Clearfork Academy as needed for certain accounts assigned.

AGE/PATIENT POPULATION(S) SERVED

Age of Patient Population Served: Adolescent and Young Adult Males/Females

Population Served: Persons meeting DSM 5 criteria for substance use disorders with or without co-occurring psychiatric illness.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Conduct and understand insurance verification/benefits

2. Provide perspective new patients with financial counseling summary based on benefits from patients’ insurance(s).

3. Provide existing patients with financial counseling summary based on benefits from patients’ insurance(s) when requested by the patient.

4. Update the EMR system with insurance information

5. Works with providers, other departments, and site locations in a timely manner when they request clarification benefits for a patient.

6. Provides ongoing, excellent customer service and solutions to VOB issues.

7. Ensure KPI's established by leadership are being met daily, weekly, & monthly.

8. Maintain patient confidentiality and function within the guidelines of HIPAA.

9. Special projects as assigned, if needed

10. Attend department & team meetings to report the status on notable accounts and/or projects.

MINIMUM JOB REQUIREMENTS
Education: Minimum high school diploma or GED. Preferred associate degree in healthcare management, business management, or related field.
Experience: A minimum of 1 years’ experience a healthcare facility and/or office, preferably in a billing/coding role. Preferred 2 years’ experience.
Certification: Preferred but not required – Certified Professional Coder, Certified Professional Biller, Certified Outpatient Coder, or Certified Coding Associate/Assistant.
Additional Requirements: A working knowledge of the DSM-V, ICD-9 and ICD-10, CPT (Current Procedural Terminology), and HCPCS (Healthcare Common Procedure Coding System) codes, revenue codes and denial codes.