Auth Concurrent Review Specialist

Compass Health is looking for a Auth Concurrent Review Specialist to join our team in Everett, WA!

SUMMARY

The Auth Concurrent Review Specialist is a key member of the Compass AR / Finance team and liaison to the Compass E&T and Residential programs. The primary function of this role is to verify client insurance eligibility, review the admission record and clinical notes across the continued stay for plan of care, complete timely concurrent review processes with payers and ensure timeliness for service billing. This role also requires understanding of provider Revenue Cycle, expertise in behavioral health billing and knowledge of payers, eligibility verification, and expertise that enables the provision of billing / Revenue Cycle assistance to Compass Health providers and staff.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following, other duties may be assigned

• Complete tasks for all aspects of the concurrent review program, which includes insurance verification, initial / concurrent authorization processes for all of Compass Health bed day programs (E&T, Residential).
• Develop rapport with and daily working relations with program clinicians to monitor that ongoing, comprehensive clinical information is both documented and available in timely fashion to facilitate initial clinical reviews, notifications and authorizations for admission as well as continuing stay review approvals and authorizations.
• Utilize electronic medical record (EMR) functionality to maintain client data and perform bed board billing functions for client stay billing upon discharge or at time deemed appropriate by Clinical / Revenue Cycle leaders.
• Maintain daily communications and documentation with Accounts Receivable (AR) team to ensure timely verification of client insurance, eligibility updates and claim submission.
• Coordinate insurance authorizations through provision of appropriate clinical information (confirmed by documentation) to insure optimization of authorizations. Develop ongoing relationships with insurance case managers to maximize authorization potential.
• Communicate with clinical teams to ensure timely discharge planning is in place when insurance authorizations expire; coordinate the search for clinically appropriate alternatives from treating clinicians and clinical teams.
• Prepare and submit concurrent review and concurrent review appeal information to payer utilization review teams on a timely basis based on payer guidelines.
• Serve as primary lead on client eligibility / medical necessity / authorization denials through collaboration with clinical and AR teams. Respond to payer requests for information to prevent denials / recover payment.
• Maintain accurate data for authorization approvals, denials and appeals (in coordination with AR team and management).
• Notify clinical teams and leadership of client stay transition activities and delays to assist with reducing length of stay and improving quality of care.
• Notify clinical and AR teams and leadership of concurrent review status / delays and coordinate concurrent review / appeal activities as applicable.
• Meet timeframes for concurrent reviews / appeals as specified by payers, State and Federal regulations.
• Prepare and assist with data and report generation and analysis for Finance department, as well as payers and regulatory agencies for bed day services.
• Request / Obtain / Prepare / Provide medical records and other documentation in normal pursuit of admission, concurrent review and appeal activities.
• Respond to questions from management and other agency staff.
• Participate in regularly scheduled supervision and team meetings.
• Remain compliant with required trainings and certifications.
• Behave in an ethical and professional manner consistent with agency policy, state law, and licensing entities if applicable.
• Understand and practice safekeeping of client protected health information per Compass Health's HIPAA and other agency policies and procedures.
• Demonstrate respect for diversity and a commitment to developing multicultural competency and sensitivity.
• Demonstrate commitment to Compass Health's Strategic Intention, Core Values and Core Competencies.

EDUCATION / EXPERIENCE / CERTIFICATIONS / LICENSES

• High School Diploma or equivalent required, AA or BA Degree in a health care or social services related field.
• Any combination of recent experience working on authorization and concurrent review tasks on behalf of a provider organization for a minimum of 3 years.
• Experience in providing care coordination or case management services preferred.
• Experience utilizing / navigating an electronic medical record (EMR) system, bed board billing functionality within EMR, and payer portals for communicating regarding client stays, appeals, etc.
• Understanding of managed care organizations (MCOs), Medicaid, Medicare and commercial payers, and experience working with payers to resolve claim issues.
• Demonstrated knowledge of behavioral health issues, or interest and ability to learn.
• Experience working in a social service environment preferred.

KNOWLEDGE / SKILLS / ABILITIES

• Demonstrated organizational skills with an emphasis on attention to detail.
• Ability to track multiple projects/deadlines and maintain consistent tracking methods.
• Excellent communication skills, written and verbal.
• Excellent customer service skills and the ability to professionally and effectively collaborate with all levels of the organization.

• Highly self-motivated and directed with the ability to also work cooperatively with others as a productive team member.
• Strong computer proficiency, including keyboarding skills and intermediate knowledge of Microsoft Office products, including Excel, Word and Powerpoint.
• Ability to summarize and analyze data using Excel pivot tables and formulas.

• Ability to work calmly, effectively, and prioritize assignments in a fast-paced, high production, and high-pressure environment.
• Ability to maintain a positive, solution-focused demeanor when responding to conflicts or problems.
• Understanding of provider revenue cycle and how this relates to other departments and roles within Compass Health.
• Ability to pass pre-employment criminal background check.

PHYSICAL DEMANDS / WORK ENVIRONMENT

The employee will be working in an administrative office environment. While performing the duties of this job, the employee must occasionally lift and/or move up to 20 pounds and is regularly required to sit, stand, walk, talk, and use close vision. The noise level in the work environment is usually moderate.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job in the work environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

What we offer

• Medical, dental, and vision insurance at NO COST to full time employees
• 16 days of vacation the first year
• 12 sick days including an additional wellness day
• 13 paid holidays - 11 traditional holidays, plus 2 you choose
• $300 in professional funds per year
• Up to 5 days paid education leave
• 403(b) retirement plan with up to 2% company match after the first year
• Automatic additional pay raises when you have your 1st and 3rd anniversary with Compass
• Mileage reimbursement
• And much, much more!!!

This totals over 45 paid days off in your first year!

Who we are

Compass Health is the region's largest private, non-profit organization providing mental health and chemical dependency services in Island, San Juan, Skagit, Snohomish, and Whatcom counties of Western Washington. We provide quality creative services to children, families, and adults in a variety of outpatient, residential and inpatient settings. We have been serving our clients and our communities for over 110 years, though our commitment to care doesn't stop with our clients as we take pride in offering our employees the opportunity to work in a culture that promotes learning, growth, and advancement. We maintain a focus on employee satisfaction and work/life balance, which includes competitive compensation and benefits programs. Please visit our website for more information: www.compasshealth.org.

Compass Health promotes equal treatment and equal employment opportunity to all applicants and employees regardless of race, creed, color, national origin, sex, religion, age, marital status, sexual minority status, sexual orientation, veteran status, or disability unless based on a bona fide occupational qualification

POSITION SUMMARY:

Job Title: Auth Concurrent Review Specialist

Program: 103-52550

Location: Everett, WA

Hours: 40 hours/week

Wage: $25.76-$37.53/hr DOE