Utilization Management Coordinator, SBH

Summary:  SMOC Behavioral Healthcare is a division of SMOC that provides substance abuse and mental health outpatient services to individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must possess at least 2-3 years’ experience billing 3^rd party insurance, work with Department of Public Health contracts.

Why Work for SMOC?

• Paid Time Off: All full-time employees can accrue up to 3 weeks of vacation, and 2 weeks of sick time and are eligible for 12 paid holidays during their first year of employment.
• Employer-paid Life Insurance & AD&D and Long-Term Disability for full-time employees.
• Comprehensive Benefits Package including Medical Plans through Mass General Brigham with an HRA Employer cost-sharing program, Dental Plans with Orthodontic Coverage, and EyeMed Vision Insurance available to full-time employees.
• 403(B) Retirement Plan with a company match starting on day one for all full-time and part-time employees.
• Additional voluntary benefits including; Term and Whole Life Insurance, Accident Insurance, Critical Illness, Hospital indemnity, and Short-Term Disability.
• Flexible Spending Accounts, Dependent Care Accounts, Employee Assistance Program, Tuition Reimbursement and more.

Primary Responsibilities:

• Interface with the billing subcontractor. Work hand in hand with representatives from the billing contractor and the clinic front office to make adjustments in the health record to ensure all activities are billable to all payors. 
• Ensure all client payor information and authorizations are entered into the electronic health record.
• Reconcile and resolve issues related to claims submissions, research and resolve eligibility issues, including contact with clients to inform of eligibility loss.
• Ensure all new and ongoing prior authorizations are entered for the Outpatient Clinic programs, Residential Recovery Programs.
• Ensure all billing to Department of Public Health is entered accurately and in a timely fashion, for the RRS and outpatient clinic programs.
• Review denials and partially paid claims and resolve discrepancies.
• Assist in resolving overdue claim problems.
• Run reports and gather data as needed for financial and operating reports.
• Recommend write-off and process in billing system as directed.
• Ensure compliance with program/department, agency and/or funder requirements, as well as, SMOC policies & procedures.
• Other duties as assigned.

Knowledge and Skill Requirements:

• Associates Degree preferred or relevant experience
• Medical and/or Mental Health third party billing experience 
• Experience with third party billing denial and resolution process
• Must have ability to handle multiple and changing priorities and meet deadlines

Organizational Relationship: Directly reports to Operations Director. Indirectly reports to Director of Residential Recovery Programs. Direct reports of this position are none.

Physical Requirement: 

• Ability to ascend and descend stairs
• Ability to see and read
• Ability to lift up to 10lbs
• Dress is business casual

Working Conditions:  As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with clients served by SMOC in various programs funded or administered through the Executive Office of Health and Human Services.

Remote Work Option: Remote work is permissible in some positions at SMOC depending on the key functions and responsibilities. The Compliance Officer position is eligible to work from home 0-60% of the week in scheduling coordination with the department manager.