VOB/UR Specialist

Who We Are: Symetria Recovery is the #1 outpatient rehab in Illinois and Texas. It started with three simple, yet game-changing core beliefs: Addiction is a disease; co-occurring mental health conditions should be addressed, and patients deserve respect, not judgement. Symetria Recovery provides comprehensive substance abuse treatment with a focus on Medication-Assisted Treatment (MAT) in a welcoming outpatient setting. Unlimited clinical services are available to our patients under our bundled-service delivery model. Key services delivered through our Opioid Treatment Program (OTP) licensure include MAT, medically monitored psychiatric care, individual therapy, group therapy (IOP), 6-day-per-week nursing care, and ongoing aftercare. Most of our patients being provided medication receive Buprenorphine products, but they can also receive Methadone, and any other FDA-approved medication for addiction. What You Will Do: The Utilization Review (UR) & Verification of Benefits (VOB) Specialist is responsible for auditing Verifications of Benefits, maintaining electronic health record (EHR) insurance information, and maintaining eligibility checks and authorizations on active clients. Reviewing VOB of each admitted client to confirm information is accurate (to include contracted services & Medicare versus Medicare Advantage coverage) Updating EHR with any VOB updates or corrections, notifying billing and/or clinic as appropriate Effective communication with the VOB partner Batch verification of every active client each month and updating EHR, clinic, and billing as appropriate, using designated workflows Communicating with clinics and pre-admit teams regarding inquiries about VOBs Manages VOB and UR portions of internal insurance change process for existing clients that present new insurance, change insurance services, or change self-pay services Submit requests for pre-certification to UR partner Review charts for medical necessities, as needed Submitting and tracking retro authorization requests, as needed Assist with any assigned projects and analysis Who You Are: Ability to work effectively in a constantly changing environment, good judgment, and capable of making decisions with attention to detail Excellent organizational skills and ability to prioritize and coordinate workload with high degree of proficiency and accuracy Strong analytical and problem-solving skills, with the ability to locate and analyze VOB and UR trends Ability to identify network used for INN payors Ability to work collaboratively with other departments and inquire about questions or discrepancies when appropriate Ability to work independently and follow through on tasks with minimal direct supervision Maintains strict confidentiality of patients’ medical records and adherence to all HIPAA and 42 CFR Part 2 laws and regulations Proficiency in Microsoft Office Excellent interpersonal communication skills History of working with insurance in substance abuse and behavioral health treatment, with preference for 2+ years' experience Benefits Available to You: Medical, dental, and vision insurance for you and your family 401(k) with company match Life insurance Pet insurance CEU reimbursement and paid time for continuing education Licensure fee reimbursement Paid vacation and sick time Closed and paid major holidays Compensation for this position is based on market analysis and will be determined by additional factors such as location/state, skills, years of experience, relevant credentials, and education. The posted compensation range for this role is $55,000 to $65,000 annually. We are committed to offering a competitive compensation and benefits package that reflects all the factors previously outlined in conjunction with current market trends. #J-18808-Ljbffr Symetriarecovery