UnityPoint Health Behavioral Health PreAuthorization Specialist in Rock Island, Illinois

  • Associate is responsible for obtaining insurance eligibility, benefits, authorizations, pre-certifications and referrals for inpatient and outpatient, scheduled and non-scheduled visits for behavioral health.

  • Associate will also update demographic and insurance information in billing system as needed.

  • Will serve as the primary documentation source for access, billing and clinical staff.

  • Responsible for resolving accounts on work queues.

  • Work with insurance companies to appeal denials.

  • Interacts in a customer-focused and compassionate manner to ensure patients and their representatives needs are met.

Primary Responsibilities;

  • Insurance verification/Certification for scheduled and non-scheduled services.

  • Obtains daily (in multiple) work queues to identify what is required by the Central Billing Office.

  • Work with providers to assure that CPT code is correct for procedure ordered is authorized when necessary.

  • Completes eligibility check and obtain benefits through electronic means or via phone contact with insurance carriers or other agencies.

  • Initiates pre-certification process with physicians, PHO sites or insurance companies and obtains pre-cert/authorization numbers and other pertinent information that secures reimbursment of account.

  • Performs follow-up calls as needed until verification/pre-certification process is complete.

  • Thoroughly documents information and actions in all appropriate computer systems.

  • Notifies and informs Utilization Review staff of authorization information to insure timely concurrent review.

  • Validates or updates insurance codes and priority for billing accuracy.

  • Works with insurance companies to obtain retroactive authorization when not obtained at time of service.

  • Works with insurance companies, providers, coders, and case managment to appeal denied claims.

  • Works with performance improvement in mind to identify opportunities to increase the efficiency of the work process and flow within the department.

  • Two years of experience in a hospital patient access/patient accounts department, medical office/clinic or insurance company required.

  • Knowledge of medical terminology, ICD coding and CPT codes is preferred.

  • Prior experience with verification, pre-certification and payer benefit and eligibility systems required.

  • Requires experience interacting with patients and working knowledge of third party payers and collections.

All below are and/or required;

Certificate of psychiatric rehabilitation from a DHS approved program plus a High School Diploma and 2 years of experience in providing mental health or human services.

A recovery support specialist certified and in good standing with the IL Alcohol and other Drug Abuse Professional Certification Association, plus 1 year experience providing mental health services.

Minimum of (5) years supervised experience in mental health or human services and High School Diploma.

Requisition ID: 2018-42697

Street: 2701 17th St

Name: 6020 UnityPoint Health QC Trinity

Name: Financial Clearance

FTE (Numeric Only; Ex. 0.01): 0.01

FLSA Status: Non-Exempt

Scheduled Hours/Shift: Fill in for current staff (Per diem, per required need)

External Company URL: http://www.unitypoint.org