Job Listing
Utilization Review & Entitlement Specialist
Company:
Douglas County
Industry:
Healthcare, Non-profit
Job title:
Utilization Review & Entitlement Specialist
Job level:
Mid
Job description:
TYPING TEST REQUIRED: Your application will NOT be considered unless you take the typing test – CLICK HERE to take the typing test now.
(NOTE): The first and last name you enter on the typing test and this application must be exactly the same. DO NOT PLACE A SPACE AFTER YOUR NAME AND DO NOT ENTER A MIDDLE INITIAL ON THE TYPING TEST. If the names are NOT an exact match (including upper and lowercase letters), your typing test score will not be uploaded into your application accurately, as it is completed through an automated process.
TYPING TESTS ARE VALID FOR SIX MONTHS.
Incumbent works under the direction of the Director of Outpatient Services or designee, performing utilization review activities for the Psychiatric Outpatient Program department, supporting billing functions for Region 6 Behavioral Healthcare, and ensuring and maintaining secure entitlements.
Compensation: $24.40 – $36.87/Hour
Essential Functions:
Maintain data management tracking system ensuring current financial status for clients.
Establish and maintain effective work relationships with clients, supervisors, County employees, elected officials, attorneys, law enforcement, judges, other agencies, and the public.
Comply with Civil Service Rules, collective bargaining agreements, County policies, department policies and laws to create a cooperative, safe, respectful and quality work environment.
Conduct interviews (e.g. face-to-face, phone) assisting in the completion of required forms and procedures to receive third party payments (e.g. Medicare, Medicaid, insurance).
Work with fiscal services, expediting third party payments and intervening with appropriate offices (e.g. Social Security, Veterans, Administration, Social Services) in obtaining needed information and documentation.
Perform other entitlement services.
Prepare progress and reconciliation reports on client entitlement status.
Maintain knowledge of federal, state and local rules, regulations and procedures for third party eligibility, payments and other client benefits (e.g. Medicare, Medicaid, insurance, Veterans Affairs).
Check in patients (e.g. appointments, Medicare and health insurance eligibility).
Update Psychiatric Outpatient Chart with financial class designation notifying billing department and entitlements.
Maintain Medicaid pre-authorization and ongoing authorization for medication management (e.g. psychotropic medications) and therapy patients.
Complete billing entry and reimbursement request for Region 6 Behavioral Healthcare for CMHC programs.
Update the Central Data System (CDS) with information required for Region 6 Behavioral Health authorization and billing.
Conduct follow-up gathering information and determining reimbursement delays occur, completing adjustments, complying with reimbursement policies, and resubmitting billings .
Enter patient registration and discharge information in the Nebraska Behavioral Health Systems (NBHS) (e.g. medication management, therapy).
Maintain job knowledge and skills (e.g. research, meetings, webinars, seminars, conferences, continuing education).
Respond to emergency codes assisting within level of competence and training; contact appropriate personnel for assistance and follow-up.
Participate in quality assessment activities.
Report to work with regular, consistent attendance.
Perform other duties as assigned and directed.
Education and Work Experience and Other Requirements:
High school diploma or equivalent required.*
Three (3) years of clerical experience required.*
One (1) year of medical billing or accounts receivable experience required.
One (1) year of behavioral health setting experience required.
Two (2) years of MSOffice experience required.
Current basic life support/cardiopulmonary resuscitation (BLS/CPR) and completion of Crisis Prevention Intervention (CPI) training within 12 months of hire required.
Must be able to type/keyboard 45 net words per minute.
Completion of a pre-employment criminal record check and conditional offer drug screen required.
*Equivalent combination of education and work experience may be substituted for requirements on a year-for-year basis.
Physical Requirements & Working Conditions:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work is generally performed in a psychiatric facility. Noise level is usually moderate to loud. Work hours are typically standard day-shift hours; however, schedule may vary (e.g. weekends, holidays, overtime/extra hours, emergency call-in). Work may be stressful when dealing with time constraints, multiple/changing priorities, limited resources, uncooperative/irate individuals and emergency situations.
Work requires some physical activity, including extended periods of sitting, frequent standing, walking, reaching, and occasional bending, kneeling, climbing, stooping, crouching, and balancing. Work also requires the ability to frequently lift/carry objects weighing up to 10 pounds and occasionally up to 25 pounds.
Required sensory abilities include vision, hearing, and touch. Visual abilities, correctable to normal ranges, include close, distance and color vision, depth perception, and the ability to adjust focus. Communication abilities include the ability to talk and hear within normal ranges. Incumbent must possess the hand-eye coordination and manual dexterity necessary to operate computers and other equipment.
Positions available:
1
Posted on:
March 13, 2025