Insurance Verification & Authorization Specialist - Farnum

$41,600 - $41,600/Yr

Easter Seals Nh - Manchester, NH

Full-time

Manchester, NH

About the position

The Insurance Verification & Authorization Specialist at Easterseals New Hampshire plays a crucial role in ensuring that clients receive the necessary insurance authorizations for their treatment services. This position involves reviewing client records, coordinating with insurance payors, and maintaining the integrity of clinical documentation to support ongoing care and compliance with insurance requirements.

Responsibilities

• Review the overall client record to gather clinical information needed to obtain payors' authorization for all services provided or to be provided by Farnum to clients.
• Complete concurrent reviews with payors for authorization of continued level of care, internal step-downs to lower level of care, and transfers out, notifying payors and other appropriate entities of client discharges.
• Anticipate upcoming reviews and work with assigned clinician and/or case manager to ensure proper documentation is complete.
• Verify daily the authorized days for entire assigned caseload and obtain additional authorization from insurance carriers or other entities as needed.
• Monitor and evaluate each client's clinical documentation for elements essential for concurrent reviews and overall record integrity.
• Ongoing verification of clients' eligibility and coverage of services by insurance carrier, NH Medicaid, MMIS (daily check) and state funded resources.
• Establish and maintain positive, effective relationships with insurance vendors and clinical staff regarding clients and/or clinicians with any insurance issues.
• Enter authorization numbers and other information into EMR and patient contact log.
• After contacting insurance provider, enter verification of benefits (VOB) into EMR.
• Run Outpatient reports daily (by 8:30am) to notify Outpatient staff.

Requirements

• High School Diploma or equivalent and five (5) years' experience in a substance use disorder environment and three (3) years' experience in a related field.
• Associates Degree in a related field preferred.
• Exceptional verbal and written communication skills and ability to articulate care plans to payors of treatment service.
• Critical thinking and problem-solving skills.
• Knowledge and understanding of the American Society of Addiction Medicine (ASAM) criteria.
• Valid driver's license and reliable transportation.

Benefits

• Medical, Dental, Vision, Life & Disability
• PTO begins accruing on your first day!
• 10 Paid Holidays - includes a floating holiday of your choice
• 403(b) employer match up to a maximum of 3%
• Tuition reimbursement after one year of employment
• Student loan repayment for qualifying degrees after one year of employment
• Wellness programs: nutritional counseling services, reimbursement programs for weight loss & tobacco cessation