SUMMARY:

Responsible for leading and managing the quality program to include efficiency in thorough assessments and claims management; develops and coordinates all aspects of billing from submittals to audits, checklists, and continuous quality improvement activities; collaborates with the team and carriers to ensure proper and timely billing. Manages and facilitates quality meetings with a focus on troubleshooting client needs, aligning with teams to deliver quality services

Assists Director to identify, write and publish policies that apply to processes and procedures, supporting a solid and timely quality initiatives. Develops staff trainings, conduct training seminars, and evaluate competency of training participants while focused on quality and quality improvement. Monitors compliance in quality improvement activities.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Responsible for submitting and processing pre-authorizations for services and programs, confirming eligibility and benefits verification for treatments.

• Review billing for accuracy and completeness, obtaining any missing or incomplete information to submit and/or resubmit.

• Prepare, review, and transmit claims, following up on denied claims or request for additional information.

• Communicate withgovernment-supported insurance coverage programs, commercial insurance companies and grant-supported coverage to effectively seekpre-authorization or process of claims to include any discrepancy in payments if necessary.

• Research and appeal denied claims in a timely manner to ensure no loss in coverage.

• Track benefit usage and advise appropriate parties of exhaustion of benefits.

• Work with clients, answering coverage inquiries.

• Schedule and conduct intake assessments, coordinating services while monitoring progress and submission of claims.

• Assist, as needed, in the development and implementation of system improvement trainings to address deficiencies identified during standard audit procedures.

• Determine records to be released by reviewing request in accordance with HIPAA guidelines and obtaining pertinent patient information from various sources, including electronic, off-site, or physical records that match request.

• Assist Director to develop performance improvement targets for quality, service, and efficiency of services and programs.

• Performs audits of client records and clinical documentation for compliance with state licensure, Medicaid, CARF and other regulatory agency requirements for all programs.

• Ensure and uphold the confidentiality requirements of all client records and manage all daily tasks and activities consistent with HIPAA, state and federal laws and regulations, as well as agency policies and regulations regarding confidentiality and security.

• And other duties as assigned.

QUALIFICATIONS:

• Bachelor's degree in similar field or discipline required from accredited college or university; Masters or Ph.D. preferred.

• Minimum 3 years' supervisory experience in a day treatment) residential or hospital setting with a minimum of 2 years' experience with substance abuse treatment.

• Must possess exceptional management skills, be highly organized and able to work well with clients and professionals at all levels in the organization.

• Must have strong leadership and communication skills as well as a thorough understanding of treating clients with substance and abuse and behavioral health care issues.

• Must successfully pass a background check and drug screen/test.

• If applicable, must possess a valid GA state driver's license and liability insurance minimums as outlined in Caring Works Liability insurance coverage.

REQUIRED SKILLS:

• Excellent interpersonal, analytical, research, presentation, written, and oral communication skills.

• Ability to multi-task, manage and organize projects, and assist with fundraising projects.

• Efficiency in Microsoft Office software to include Word, Excel, Outlook.

• Ability to work independently and manage multiple priorities.

PREFERRED SKILLS:

• Efficiency in Google Docs/Google Drive.

• Ability to work with at-risk client populations (i.e. chronic illness, mental illness, substance abuse, etc.).

• Experience in quantitative and qualitative analytical methods.

Job Type: Full-time

Pay: From $57,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• Utilization review: 1 year (Preferred)

Ability to Commute:

• Decatur, GA 30033 (Required)

Work Location: In person