Care Coordinator

Statement of Purpose

Under the direction of the Licensed Clinical Care Coordinator, the Care Coordinator initiates calls with potential patients and insurance companies, verifies insurance benefits for patients’, performs utilization review and outreach to insurance companies to update and obtain private insurance contracts.  The CC is a member of a multidisciplinary team; essential duties include but are not limited to: verification of benefits, insurance navigation and client advocacy with providers. Communicates in a professional manner, obtains accurate information and advises team and patient.

Major Tasks, Duties and Responsibilities

• Verifies and confirm insurance coverage with insurance companies by diagnostic and procedural codes.
• Provide a centralized contact point between BHS service providers, Insurance companies and patients.
• Must have excellent written and verbal communication skills.  Be familiar with insurance terminology, types of policies and insurance industry rules.
• Responsible for reviewing patient’s case and insurance coverage information and determine if there are any co-pays or other insurance requirements.
• Be familiar with all patient treatment and provide information for Payor
• Ensure timely processing of benefit information.
• Participate in utilization review
• Support billing reconciliation
• Be an advocate for patients with providers.
• Respond to treatment team and patient inquiries by phone and email.
• Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.
• Knowledge of drug and alcohol dependency, mental health, family and systems.
• Ability to demonstrate ethical and professional behavior.
• Ability to convey respect for cultural and lifestyle diversities of clients and staff.
• Basic knowledge of referrals, both inside and outside of the BHS treatment system. 
• Basic understanding of computer operations; Windows and word processing.  Ability to readily adapt to the indicated automated information system.
• Other duties may be assigned

 Care Coordinator Competencies and Performance Expectations:

• Verify insurance benefits
• Communicate with insurance companies, preauthorize admits and coordinate continued and/or extended care benefits.
• Communicate and advocate patient care needs with insurance companies and BHS staff
• Maintain record system of private insurance patients
• Adhere to professional standards

Prerequisite Qualifications

Following are the qualifications required to perform the essential functions of this position.  Qualifications may be subject to modification based on the Americans with Disabilities Act.

Bilingual abilities may be required within certain BHS programs.

Bachelor’s Degree in a in health or human/social service or related field related field.  Certification as a chemical dependency counselor.  Minimum of five years working in substance abuse. Knowledgeable of insurance benefits and medical terminology.

Must have valid California driver’s license and liability insurance if driving personal vehicle on BHS business.

Vision, hearing, manual dexterity and eye-hand coordination must be adequate for performance of job duties.  Able to sit at desk, use keyboard, write and physically perform other job duties.  Able to move about the facility.

Specific qualifications may vary based on assignment. The supervisor will initial those items on the following list, which apply and write N/A to indicate those qualifications, which are not applicable:

_____  Class “C” California Driver’s License.

_____  Personal vehicle with liability insurance for reimbursable mileage, generally short distances.

_____  First Aid certification, obtain within 90 days of employment and maintain current thereafter.

_____ CPR certification, obtain within 90 days of employment and maintain current

thereafter.

_____ Bi-lingual (specify: ___________________)

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements which may be inherent in the position.

Salary : $21 - $23