Benefits Specialist

The Benefits Specialist is responsible for verifying clients' insurance coverage, benefits, and eligibility for treatment. They communicate with insurance providers to confirm coverage details, obtain necessary authorizations, and coordinate primary and secondary plans. Their role is critical in streamlining the admissions process, preventing billing issues, and supporting both clients and the facility in navigating insurance requirements efficiently.

About Us

Benefits for full time employees:

• Medical, Dental, and Vision plans through Anthem.
• FSA/HSA Accounts.

• Life/AD&D insurance through Anthem, 100% paid for by the employer.

Other benefits include:

• 401k plan with employer match.
• PTO, Self Care Day, and Floating Holiday.
• Educational Assistance Reimbursement Program.
• Employee Assistance Program.

• Health and Wellness Membership.

QUALIFICATIONS:

• Must be 18 years or older to apply for this position.

• Must be able to pass a criminal background screen.

• Physical Requirements: Ability to work on a computer/keyboard, use electronic systems, communicate with others through written and verbal formats, ability to sit for long periods of time, listening, reading comprehension, lifting up to 10 lbs.

To perform this job successfully, an individual must be able to perform each essential job function assigned satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge, Skills, and Abilities:

• Ability to operate standard office machines and equipment, including telephones, computers, copy machines, fax machines, calculators, scanners, and shredders.
• Ability to be professional and maintain a positive attitude and relationships with coworkers.
• Ability to efficiently operate within the Salesforce CRM system.
• Excel at both written and verbal communications to convey essential information; must be able to utilize the proper linguistic syntax and spelling.
• Knowledge of clinical and medical terminology as it relates to the delivery of clinical care to the clients within our programs as required by our payers.
• Knowledge of the clinical, medical, and miscellaneous services provided to the clients.

• Ability to use computer software including Microsoft Office, Adobe Acrobat, and G Suite products.

RESPONSIBILITIES:

The Benefits Specialist will be responsible for all the following, and additional duties may be removed or assigned as needed. These include but are not limited to:

• Contact insurance companies to verify eligibility and insurance benefits.
• Update and maintain online insurance portal logins (i.e., Availity), insurance carrier phone numbers, claims mailing addresses, electronic payer IDs and timely filing limits.
• Report any new information, trends and changes from health insurance carriers directly to the VOB Manager or Billing Director.
• Maintain knowledge of all practices/facilities within the organization and the levels of care provided.
• Distinguish between in-network and out-of-network payors while monitoring any new executed contracts via communication with the Billing Director.
• Coordinate and communicate with other departments as needed to obtain necessary information to complete eligibility and benefit verification.
• Have an understanding of insurance healthcare terminology relating to patient demographics, eligibility, coverage, benefits, maximums, exclusions, limitations, authorizations, reimbursements and other industry terms relating to behavioral health.
• Monitor the insurance verification queue, fill out and complete verification of benefits forms with speed and accuracy, send back for additional information if needed, etc.
• Daily reporting of verification of benefit activities and keeping supervisor apprised of all matters regarding VOB’s.
• Apply knowledge of company policies and represent AMFM Healthcare in a professional manner.