JDC IOP Insurance Specialist

JDC IOP Insurance Specialist -34664University Staff

Description

University of Colorado Anschutz Medical Campus

School of Medicine Department of Psychiatry

Job Title : JDC IOP Insurance Specialist

Position : #00826736 Requisition : #34664

Job Summary :

The Insurance Specialist will report to and serve under the supervision of the Business Services Manager and Program Director at the Department of Psychiatry.

This position is responsible for managing various aspects of patient and administrative duties of the clinic. The Insurance Specialist will create a positive impression for each patient, family member, visitor, staff while performing tasks of, insurance review, prior authorizations, obtaining demographic information, explain financial requirements to the patient or patients representative and collect the outstanding patient portion prior to or at the point of service under minimal supervision, performs a variety of patient and clerical duties as assigned.

Key Responsibilities :

• Evaluate patient complaints and insurance issue presented to Insurance Specialists to make recommendations on the best course of action.
• Conducts regular insurance staff meetings and continues to develop best practices across all DOP clinics to increase efficiency.
• Evaluates and communicates patient’s potential financial liability directly to the patient prior to medical services being rendered based on insurance verification data and medical cost estimates.
• Obtain insurance authorization and pre-certification for behavioral health services. Includes obtaining and documenting covered and non-covered benefits, plan type, copayments, co-insurance, out of pocket, and deductible amounts and determining contract and benefit eligibility.

Contact insurance companies as needed.

• Review, process and audit the medical necessity for each patient behavioral health treatment and documentation insurance authorization including review of CPT / ICD diagnosis codes.
• Work as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
• Communicate with patient access and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans.
• Communicate back to site on insurance update / status within 24 hours of receipt of authorization request; stat requests require same day update on insurance authorization to providers.
• Process insurance / patient correspondence, including denial follow-up. Maintain reimbursement correspondence and filing systems.
• Maintain a good working knowledge of behavioral health authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.

Comply with patient confidentiality laws and regulations.

Work Location :

Hybrid this role is eligible for a hybrid schedule of 2-3 days per week on campus and as needed for in-person meetings.

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