Position Summary:

Person in this position is responsible for collecting clinical information and communicating with MCOs in a timely manner in order to advocate for the highest level of care that is supported by the clients acuity, and in compliance with regulations as defined by WestCare and its regulatory and accrediting agencies. Person in the position is also responsible for communicating with insurance companies/payor sources as an advocate for the patients served. Essential functions include those listed below

Essential Job Functions:

Establish and maintain positive and frequent effective communication with insurance carriers Read and understand patient/members running chart narrative and respective case notes and be able to disseminate patient needs and professional/clinical recommendations and communicate this information effectively Call in intakes and/or peer to peers and get the patients appropriate level of care authorized Obtain and communicate level of care and authorizations and properly enter information into the systems. Manually complete and submit quality authorization documentation to insurance companies Serve as an advocate for patient members in relation to their care and their insurance benefits Responsible for tracking current & concurrent authorization needs in all levels of care Responsible for detailed system documentation of accounts Communicating with other departments to obtain or provide needed information on patient accounts. All other related duties as assigned