BEHAVIORAL HEALTH REFERRAL/ AUTHORIZATION SPECIALIST

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Position Title:  BEHAVIORAL HEALTH REFERRAL/ AUTHORIZATION SPECIALIST

General Description:

The BH Referral / Authorization Specialist is responsible for calling English and Spanish speaking clients referred to the BH Dept. and MAT Program. Specialist will engage with the client and complete all necessary screening tools over the phone with the client. He/she will assign client to a Caring Health clinician whenever possible and schedule the intake appointment. Specialist will then complete the insurance authorization and enter confirmation number and allowed visits into EPIC. Specialist will refer some clients to collaborating agencies as dictated by insurance, client diagnosis and needs. They will keep track of new and pending referrals for BH and MAT in EPIC. Candidate will document in EPIC all of this work and send inbasket to the assigned clinician alerting them to the new client. As needed candidate will report to and consult with the Billing Manager and staff.

Reports to:                   Director of Behavioral Health

Supervises:                  N/A

Salary/Status:               Non-Exempt

Minimum Requirements:

  • Spanish, Bi-lingual required
  • Associate degree in Social Services or Business Administration preferred.
  • At least one year’s experience in working with Third Party payers or an equivalent combination of education and work experience.
  • Basic understanding of Behavioral Health and Recovery disorders.
  • Respect, compassion and non-judgmental attitude toward clients who have BH/Recovery diagnoses.
  • Professional and respectful attitude required at all times while working with clients and staff.
  • Effective written and oral communication skills.
  • Ability to document activities in a professional, concise and accurate manner.
  • Good decision making and organizational skills.
  • Willing to work independently and as a Team member.
  • A strong desire to help CHC clients as needed within the parameters of the job description.

Principle Responsibilities and Duties:

  1. Always speak with staff and clients with respect, concern and demonstrate friendly attitude with willingness to assist
  2. Maintain confidentiality of clients and CHC information.
  3. Check insurance eligibility of all clients referred for BH or MAT service.
  4. Complete all steps of the Referral and Authorization Protocols accurately and document all in EPIC
  5. Complete all screening tools with client over the phone.
  6. Contact Insurance companies to obtain the necessary authorization for services and document in EPIC
  7. Make Intake appointment for assigned client.
  8. Communicate referral information to the assigned clinician
  9. Send EPIC inbasket to referring Providers.
  10. Assist clients referred to other agencies in contacting and making first appointment. Document this in EPIC.
  11. Assist clinicians with request for re-authorizations by keeping track of authorizations in EPIC.
  12. Enter, maintain and submit all documentation in a timely manner according to BH policies.
  13. Participate in appropriate team conferences, staff meetings, in-services, trainings and consults with physicians and CHC staff to ensure continuity of care.
  14. Learn and remain updated with insurance regulations about requesting authorizations for treatment with various insurance companies.
  15. Work with payer sources and billing department to collect and manage needed information for timely and accurate billing purposes
  16. Mastery of EPIC/OCHIN functionality in CHC’s Integrated Health Record.
  17. Demonstrate dependability and responsibility for this position by arriving on time for work, punching in/out for lunch and for start/end of the day.
  18. Willingness to be flexible if situations demand adjusting work times, breaks and lunch times.
  19. Complete annual HIPPA training and exam successfully
  20. Comply with all CHC policies and protocols.
  21. Cover the front registration desk as needed for lunch, break, sick and vacation times.
  22. When covering for front desk, Referral Specialist accurately completes CHC registration and check in/out procedures in EPIC.
  23. Make new appointments for clients
  24. Make reminder calls to clients for all scheduled appointments.
  25. Answer phone calls and voicemails with respect and concern for clients’ needs. Forward messages if needed, resolve issues if possible.
  26. Gives releases and contracts to treat to all new referrals in Caring Health Center BH Dept.
  27. Gain familiarity of processes within CHC to assist clients in obtaining or changing insurance if needed.
  28. Comply with all processes and regulations pertaining to Caring Health Center, insurances and HIPPA
  29. Adhere to Federal/State guidelines, rules regulations, statutes and law for client care and insurance.

Working Conditions:

  1. This position requires the ability to use a computer workstation, and use of an Electronic Medical Record.
  2. Collaborate with BH Team members.
  3. Must be flexible and willing to complete tasks not mentioned here for the good of BH clients, BH Dept. and to support the CHC mission.
Location: Springfield, MA
Apply for this Position Job code: 1000073
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