Regional Financial Services Specialist

3 weeks ago

Alameda, United States Telecare Corp. Full time

Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals with complex needs in recovering their health, hopes, and dreams. Telecare continues to advance cultural diversity, humility, equity, and inclusion at all levels of our organization by hiring mental health peers, BIPOC, LGBTQIA+, veterans, and all belief systems.

Full Time; AM 8:30 am - 5:00 pm; Monday - Friday

Expected starting wage range is $25.79 - $31.87. Telecare applies geographic differentials to its pay ranges. The pay range assigned to this role will be based on the geographic location from which the role is performed. Starting pay is commensurate with relevant experience above the minimum requirements.

POSITION SUMMARY

The Regional Financial Services Specialist position is responsible for managing financial eligibility, authorizations and single case agreements. This includes, requesting, tracking, follow up and data entry into the electronic health record system for all admissions for assigned programs in the region. The focus of this position is to work closely with assigned programs to ensure that all client's financial records have accurate payer information upon admission and maintained monthly. The Regional Financial Services Specialist position will require a comprehensive knowledge and understanding of Medicare, commercial insurance and managed care health plans, along with understanding Medi-Cal CERTs to interpret coordination of benefits. This position is a liaison position between the programs and the corporate Revenue Cycle Department.

QUALIFICATIONS

Required:

* High school Diploma or G.E.D.
* Minimum five (5) years professional experience in a healthcare billing
* Ability to read, write and speak English
* Strong analytical and time management skills and attention to details
* Ability to work and communicate effectively with customers, government representatives, management and staff
* Professional knowledge of Medicare, Medi-Cal/Medicaid, managed care health plans and commercial insurance plans
* Knowledge of CPT, HCPCS and medical terminology
* Extensive knowledge of insurance plan benefits and limitations
* A comprehensive understanding of managed care health plans
* Availability to work overtime, as needed
* Must be at least 18 years of age
* All opportunities at Telecare are contingent upon successful completion and receipt of acceptable results of the applicable post-offer physical examination, 2-step PPD test for tuberculosis, acceptable criminal background clearances, excluded party sanctions, and degree or license verification. If the position requires driving, valid driver license, a motor vehicle clearance and proof of auto insurance is required at time of employment and must be maintained throughout employment. Additional regulatory, contractual or local requirements may apply

Preferred:

* Two (2) years college level education

ESSENTIAL FUNCTIONS

* Demonstrate the Telecare mission, purpose, values and beliefs in everyday language and contact with the internal and external stakeholders
* Functions as the primary point of contact between assigned programs and Revenue Cycle for insurance and authorization related issues
* Deciphers insurance coverage and benefits to ensure accuracy of all revenue cycle activities for assigned programs
* Accesses various websites or secure portals to obtain client eligibility status
* Updates the electronic health system (Avatar):

o Financial Eligibility

o Authorization Management

o Single case agreements

o Follow up Entry (Notes)

* Maintain a monthly member benefit tracking record to ensure that month to month benefits remain accurate
* Reviews daily admissions/census for all members served to determine Revenue Cycle intervention appropriateness
* Maintains and expands knowledge base on payer requirements for both contracted and non-contracted entities
* Prepare and submit request for authorization of services provided to our clients, including initial authorization, extension or subsequent when needed
* Review clinical data, diagnosis and procedure codes for authorizing request
* Identify when a single case agreement is necessary, notify program/corporate office and initiate and complete the process; including follow up and Avatar entry
* Track status of authorization requests and follows up with payer to ensure authorization is granted, paying close attention to authorization dates spans and service codes
* Resolve any authorization discrepancies with payer
* Actively participate in problem identification and resolution and coordinate resolutions between appropriate parties.
* Communicate daily with program staff to secure client information and documentation
* Develop and maintain professional, service-oriented working relationships with members served, clinicians, social workers, management and external parties in a courteous and efficient manner
* Analyze data, perform multiple tasks and work independently as well as in a team environment
* Prioritize daily work and assesses workload situations
* Plan, organize, prioritize, and execute multiple, continuing assignments with general instructions

Duties and responsibilities may be added, deleted and/or changed at the discretion of management.

SKILLS

* Ability to use Microsoft Office Suite, including Word, Excel, PowerPoint, etc.
* Practical knowledge of computer applications for database and presentation, electronic health records, and web-based applications, internet and calendaring software
* Excellent oral and written communication skills
* Type 40 WPM

PHYSICAL DEMANDS

The physical demands here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

The employee is constantly required to sit and occasionally required to stand, walk, reach, twist, bend, pull and lift and carry items weighing 10 pounds or less as well as to do simple grasping. The position requires manual deviation, repetition and dexterity. Visual requirements include computers and books exposure.

EOE AA M/F/V/Disability

If job posting references any sign-on bonus internal applicants and applicants employed with Telecare in the previous 12 months would not be eligible.

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