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Billing Specialist and Admissions

Classification: Full-time, non-exempt

Minimum Qualifications: Minimum two years of college or associate degree in a human service-related field or LADAC eligible. Minimum two years of experience working in substance abuse treatment admissions/medical records. Demonstrated experience conducting insurance precertification

and continued stay reviews, client assessments, and billing Specialized clerk training with

one year related experience; ability to type 60 wpm.

Job Summary: Responsible for working collaboratively with the Clinical Director, Admissions Director, and UR/Billing/IT Lead to assist with conducting precertification and concurrent reviews with insurance organizations, managing insurance billing, compiling monthly reports, completing state billing (TnWits), and auditing client electronic and paper records. Consistently maintain client and program-related records per agency standards; collect data and prepare statistical reports; provide clerical services to clinical staff as required; answer agency telephone as directed; perform other related duties as required. Assume the Admission Director’s job duties when the Admission Director is unavailable. Assume the UR/Billing lead role when the UR/Billing/IT Lead is unavailable.

Duties: Ensure client insurance coverage and benefits

Works collaboratively with the Deputy Director, Admission Director, Clinical Director, and UR/Billing/IT Lead, utilizing ASAM criteria to complete thorough and timely precertification and continued stay reviews for residential and intensive outpatient programs.

Assist with submitting insurance billing information to managed care organizations, and address payments and denials of payment.

Assist with submitting all required documentation to managed care organizations, PINs, discharge summaries, and required release of information forms. Assist counselors in scheduling required TnCare discharge appointments as needed.

Manage and conduct state billing in TnWits system. Enter TnWits encounters weekly. Assist with balancing the SRC database to TnWits each month.

Assist with conducting Level I record audits for admissions and UR/billing per applicable agency policy and procedure.

Interview clients on the telephone for pre-screening and assist admissions in scheduling screening appointments.

Assist with the maintenance of SRC and TnWits database. Enter admissions, discharges, transfers, release of information, census, etc. Assist with running end-of-month reports.

Ensure electronic census is distributed daily, client information cards are updated and maintained, and client treatment records are processed per confidentiality laws.

Ensure adequate inventory and use of program forms, admission packets, client handbooks, verification letters and certificates, and client emergency contact log.

Ensure initial client records are finalized, additions filed, assessments completed, and bed assignments/waitlist monitored.

Assist with the daily operations of the court liaison, including assuming the role when the court liaison is unavailable.

Participate in Professional Staff Organization meetings

The Employer retains the right to change or assign other duties to this position.