Job Details

Position Summary:

Person in this position is responsible for coordinating the inpatient admissions process including insurance

pre-authorization for admission. Preferred candidate to have experience working with health insurance companies,

performing account set-up & management, have medical terminology knowledge, possess excellent computer skills and

be detail oriented. Experience in Behavioral Health setting is also preferred.

 

Essential Job Functions:

• Meets with each new client on admission and accurately inputs all necessary financial and/or insurance information

into agency database.

• Verifies insurance by checking enrollment and funding status in multiple databases and documents insurance

benefits in admission database prior to admission.

• Facilitates completion of any client information, financial payments, authorizations or other documentation at the

time of admission.

• Calculates copayments and/or private fees and provides an invoice to client prior to discharge.
• Maintain proper balance regarding source of payment (fee for service, Medicaid, public, private, and third-party

payers)

• Responsible for educating clients on benefits and opportunities within the WestCare system.
• Resolves any issues with coverage and escalates complicated issues to the billing manager and/or director.
• Coordinate with the billing manager to assure all admissions/transfers/discharges are completed within the

appropriate time frame.

• Work collaboratively with treatment teams of all programs, communicating information needed to maximize good

customer service to clients, referral sources and third party payers.

• Maintain daily census and provide census information to internal and external sources on a timely basis.

Essential Qualifications:

Certifications/Licensures:

• HIV/AIDS 104 Basic Education and valid CPR Certificates are required. 20 hours of continuing education required

annually.

 

Education:

• High School Diploma or equivalent is required
• Graduation from an accredited two-year college with an associates degree is preferre

 

Experience and Competencies:

• 2 years admission review experience preferred.
• Previous experience in Medicaid/Managed Care preferred
• Maintains confidential files and records
• Working knowledge of behavioral health terminology
• Admissions and insurance verification experience, preferred
• Proficiency in Microsoft Office Platform Applications and knowledge of HIPAA regulations and guidelines.
• Knowledge of managed care and reimbursement principles.
• Understanding and proficiency in MCO & State Medicaid Chapter requirements
• Collaboration, negotiation, and assertiveness skills.
• Must be organized, detail oriented and have the ability to focus on several job-specific tasks with several potential

surrounding distractions and patient traffic.

• Excellent verbal and written communication skills.
• Critical thinking and problem solving skills.

• Must be able to work in a team environment.
• Ability to perform complex tasks and to prioritize multiple projects.
• Strong analytical and critical thinking skills and the ability to analyze, summarize, and effectively present data.
• Ability to work collaboratively with others in a manner that is pleasant and professional.
• Ability to exercise good judgment and discretion.
• Ability to operate a computer and complete documents in Microsoft program formats.
• Ability to complete work tasks within scheduled work hours.
• Excellent verbal and written communication skills.
• Knowledge of WestCare Mission, goals and values
• Knowledge of Incident Reporting
• Knowledge of HIPAA, Professional Ethics, Consumer Rights and Confidentiality
• Familiarity with WestCare services and programs
• Understanding of issues related to cultural identity, ethnic background, age, developmental level, gender and

sexual orientation in prevention, intervention and treatment.

• Demonstrates ability to work effectively with culturally diverse staff and consumers
• Demonstrates respect for an individual’s cultural and ethnic values when interacting with them
• Articulates a working definition of trauma
• Understands the impact of trauma
• Understands re-traumatization
• Demonstrates a high degree of dependability.
  • Maintains a good attendance record.
  • Observes working hours
  • Shows flexibility and is responsive to requests from supervisor
  • Works independently with minimal supervision
  • Exhibits characteristics of good workmanship, and integrity on the job
  • Work time is always productive
• Demonstrates ability to establish and maintain effective working relationships with consumers, co-workers, external

partners, and regulatory agencies

• • Is courteous to consumers, staff, and all others.
  • Demonstrates tact at the appropriate time.
  • Cooperates with others both within and outside WestCare.
  • Works well with supervisor; accepts direction and supervision
  • Maintains a positive attitude toward work
• Ensures and maintains a safe working environment.
  • Work area is clean and orderly.

• Verbalizes, understands and adheres to agency safety procedures.
• Demonstrates appropriate use of Unusual Incident Reports, in accordance with the Center’s reporting procedures
• Presents a positive personal image
• Dresses and maintains a professional demeanor
• Excellent communication skills;
• Ability to exercise good judgment and discretion;
• Ability to work well in a team environment;
• Adherence to the highest standard of ethical conduct, especially to standards governing confidentiality;
• CPR Certification, First Aid Certification and an annual Tuberculosis test.
• Ability to provide an Affidavit of Good Moral Character
• Clearance in Pre-Employment Drug Testing and Criminal Records Checks, as required.

Working Conditions:

• Work is primarily performed in an office or residential treatment setting

 

Essential Physical and Mental Demands of the Job

The employee must be able to perform the following essential duties and activities with or without accommodation:

 

Physical Demands:

• Use of computer and telephone systems is required which includes coordination of eye and hand, and fine

manipulation by the hands (typing, writing, and working with files).

• Requires talking: Expressing or exchanging ideas by means of the spoken word. Talking is required to impart oral

information to employees, clients, and the public, and in those activities in which the employee is required to

convey detailed or important spoken instructions to others accurately, loudly, or quickly.

• Requires hearing: Hearing is required to receive and communicate detailed information through oral communication.