Managed Care Specialist

Centerstone is among the nation's leading nonprofit behavioral health systems with thousands of employees dedicated to delivering care that changes people's lives. A dynamic, well-established organization, we offer rewarding opportunities to serve all ages in a variety of settings. Come talk to us about joining the Centerstone team!

JOB DESCRIPTION:

SUMMARY OF POSITION

Responsible for reviewing daily reports for no authorizations and works to resolve the issue. This includes future scheduled appointments with lapsing authorizations. Must maintain a working knowledge of payer requirements for proper scheduling and authorizations. Responsible for reviewing daily service activity failures with regard to authorizations. Also includes billing failures for coverage issues. Assists with obtaining benefit information and sets up coverage information to ensure proper billing. Responsible for processing of denials due to no authorizations received and works to resolve. Timely and accurate data entry.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Responsible for reviewing the daily reports for no authorizations and works to resolve the issue.
• Maintain a working knowledge of payer requirements for proper scheduling and authorizations.
• Responsible for reviewing the daily service activity failures with regard to authorizations and works to resolve.
• Provide assistance to others in determining appropriate coverage and scheduling properly credentialed/licensed providers.
• Obtain benefit information and set up coverage information within the IT systems to ensure proper billing within 48 hours of date of service.
• Update and maintain notes regarding insurance verification and changes that may have occurred.
• Responsible for processing of denials due to no authorizations received and works to resolve discrepancies with insurance companies.

• Effectively communicate via written, verbal, in person and virtual methods.

Education Level

High School Diploma or GED required.

Years of Experience

Three to five years administrative experience preferred.

Certification/Licensure

N/A

Task Percentage of Time/Frequency

Standing - 20%

Sitting - 80%

Squatting - occasional

Driving - occasional

Kneeling - occasional

Lifting - occasional

Bending - occasional

Time Type:

Pay Range:

Delivering care that changes people's lives starts with our employees. Below are just some of the great benefits Centerstone employees enjoy:

• Medical, dental, and vision health coverage
• Flexible Spending and Health Savings Accounts
• 403b retirement plan with company match
• Paid time off and ten paid holidays
• AD&D Insurance, Life Insurance, and Long Term Disability (company paid)
• Employee Resource Groups
• Continuing education opportunities
• Employee Assistance Program

Centerstone is an equal opportunity employer. Employment at Centerstone is based solely on a person's merit and qualifications directly related to professional competence. Centerstone does not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), or any other basis protected by law.

At Centerstone, we use our values as a guide for what we do. Respect, Expertise, Integrity and Empowerment are at the heart of every interaction at Centerstone, and particularly rooted in our Culture.

Our approach to culture is to create an environment that encourages, supports and celebrates the voices and experiences of our employees. We are committed to a culture of empowerment, respect, integrity and expertise that powers our innovation and connects us to each other, our clients and the communities we serve.

Centerstone is also committed to a strong culture of quality and safety, celebrating role-models who champion best practices for quality, clinical risk, and patient safety.