UM Specialist

Seven Counties Services; Louisville (KY); Remote; USD 40,000 - 52,000; Full time

Job summary

Seven Counties Services is seeking a remote-based billing administrator for the Louisville Metro region. You will verify benefits, obtain authorizations, process claims, and explain billing policies to clients and families.

Requirements include 2–3 years in insurance/managed care administration, strong communication skills, knowledge of CPT/HCPCS and revenue codes, and a typing speed of 45–55 wpm. A vaccination policy is in place and applicants must reside in Louisville Metro or Southern Indiana.

Qualifications

• Completion of up to 18 months' additional business education beyond high school.
• Two to three years of related administrative experience in an insurance or managed care setting.
• Excellent observation, analytical thinking, problem-solving, and communication skills.
• Basic knowledge of managed care and reimbursement concepts.
• Knowledgeable of CPT, HCPCS, and revenue codes.
• Excellent customer service skills.
• Typing speed of 45–55 words per minute.
• Basic computer skills.

Responsibilities

• Verify client’s mental health, intellectual disability, and/or substance abuse benefits and obtain initial authorization and subsequent authorizations.
• Identify behavioral health payer per medical plan.
• Implement tracking system to obtain recertification of services for clinicians.
• Secure information about client's financial status or insurance coverage and complete insurance forms as needed.
• Answer inquiries from clients, doctors’ offices, or third-party payers and follow through to resolution.
• Explain charges, services, and bill payment policies to clients and families.
• Perform administrative functions to complete and expedite billing, including data entry and claim preparation.
• Resolve billing problems and/or receive insurance updates.

Skills

Observation skills

Analytical thinking

Problem solving

Verbal communication

Written communication

Typing speed 45–55 wpm

Basic computer skills

Managed care knowledge

Reimbursement concepts

CPT/HCPCS codes

Revenue codes

Customer service

Education

18 months of business education beyond high school

Job description

Job Description: This is a remote position, and only candidates residing in the Louisville Metro and Southern Indiana will be considered.

ESSENTIAL JOB FUNCTIONS

• Verifies client’s mental health, intellectual disability, and/or substance abuse benefits and obtains initial authorization and subsequent authorizations, as determined by client’s health insurance plan.
• Accurately identifies behavioral health payer per medical plan.
• Implements tracking system to obtain recertification of services, as needed, for psychiatrists, psychologists, licensed clinical social workers, and licensed professional counselors.
• Secures information about client’s financial status or insurance coverage and, as needed, completes insurance forms, verifies insurance coverage, and secures other relevant information.
• Answers inquiries from clients, doctors' offices, or third-party payers and follows through to resolution.
• Understands and explains to clients and their families the charges, services, and bill payment policies applicable to them.
• Performs various administrative functions to complete and expedite the billing process including, but not limited to, recording client identification data and physician diagnosis, investigating charges, correcting and updating data, and preparing the claim to bill.
• Resolves billing problems and/or receives insurance updates.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform job‑related tasks other than those specifically presented in this description.

EDUCATION

• Completion of up to 18 months' additional business education beyond high school.

EXPERIENCE

• Two to three years of related administrative experience in an insurance or managed care setting.
• Requires excellent observation skills, analytical thinking, problem solving and good verbal and written communication skills.
• Basic knowledge of managed care and reimbursement concepts.
• Knowledgeable of medical terminology, CPT, HCPC, and revenue codes.
• Excellent customer service skills.
• Typing speed of 45 - 55 word units per minute.
• Basic computer skills.

PHYSICAL DEMANDS

Position requires lifting of 20 pounds maximum, with frequent lifting and/or carrying of items weighing up to 10 pounds. Occasional minor discomforts from continual exposure to video display terminal.

Within the bounds of their respective job descriptions, all staff are expected to exercise principle-centered leadership, focused on customer service responsiveness, with a continuous quality improvement orientation.

Additionally, all staff are expected to develop a working knowledge of and follow all policies and procedures related to safety management and other Joint Commission standards.

Time Type: Full time

Seven Counties is the provider of choice for mental and behavior health services in and around the Louisville Metro. Over 1,400 employees work in 25+ locations throughout Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer and Trimble counties; making sure that the 31,000 people we serve annually have the best chance of living their best lives.

At Seven Counties, we give our staff the opportunity to do what they do best with continued training, effective mentoring and competitive salaries and benefits.

In an effort to protect our employees, clients and community, we require the COVID and Influenza vaccinations for all employees.