Essential Job Functions: 

• Collects demographic and insurance data, registers new clients for services, verifies insurance eligibility and benefits, and enters financial eligibility and authorization data in SMA's EMR system.
• Conducts prior authorization with insurance companies for clients admitted to care.
• Notifies staff of insurance authorizations and insurance company expectations.
• Interacts directly with the clinical team at the Crisis and Detox units, MAT program and residential programs, collecting documents from the clinical team and reporting information from and to the insurance providers related to length of stay.
• Acts as an advisor to the program staff and supervisors through in-service trainings, individual meetings and written communications on all issues pertaining to the documentation expectations of insurance companies and other third party payers.
• Performs concurrent and retrospective reviews as assigned.
• Maintains a variety of spreadsheets or portals for tracking purposes.
• Writes and distributes legible, informative, and understandable notices of non-compliance issues identified through reviews of client records.
• Assists in the maintenance of SMA's compliance with treatment and documentation requirements of funding sources, performance improvement, and accreditation activities.
• Acts as liaison between SMA staff and insurance companies, funding sources, or their managed care organizations when client's health care is being managed under a managed care plan.
• Performs miscellaneous job-related duties as assigned.

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below 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.

Minimum Education and/or Experience: High school Diploma and 6 years of direct care or UR experience working in Human Services or a related field.  Graduation from an accredited school with a Bachelor's degree in a Human Services or related field and/or Certified Addictions Professional (CAP) preferred. Within the last five years must have had two years of experience in behavioral health treatment services with one year of experience in a setting where it was necessary to communicate orally and in writing to inform, advise, or train others about client issues, treatment service delivery, documentation in client records or UM principles. Experience with American Society of Addictions Medicine Patient Placement Criteria is preferred. Experience with CARF, Medicaid, and Managed Care requirements is preferred.

Knowledge/Skills/and Abilities: 

• Must be knowledgeable and demonstrate competency in current best practices of behavioral health treatment and related services, especially as it relates to documenting the course of treatment and patient placement criteria in the client record.
• Dependent on assignment, must have knowledge of typical diagnoses, treatment services, and developmental issues for adolescents in general, delinquent adolescents, adults, and pregnant/post-partum women who are admitted to a mental health and/or substance abuse treatment setting.
• Demonstrates proficiency with assigned client populations in performing utilization reviews in records of clients with specific problems and needs.
• Ability to assess age specific data and interpret age specific response to treatment. 
• Knowledgeable of most recent standards/criteria of ASAM PPC, Medicaid, MCOs, DCF, and CARF.

Necessary Special Requirements: Possession of a valid Florida driver's license, acceptable driving record, and proof of personal automobile insurance if required to drive an SMA vehicle and/or use a personal vehicle for SMA business. Complete State of Florida mandatory background screening prior to start of employment.  Complete SMA required training during the first six (6) months of employment and updated if required.

Physical: Mobility and ability to bend and reach during an 8-12 hour day. Able to lift minimum 10 pounds. Visual and auditory acuity sufficient to evaluate, intervene, treat, and record client health care needs. Fine motor skills for legible and accurate charting, daily correspondence and presentation, either manually or orally. Work endurance ability to work 8-12 hour shifts with a meal break, as possible. Routine 8-12 hour shifts. Hours and days off may vary. Extra hours may be required. Work assignment locations may vary.

Application:This class specification is intended to identify the class and illustrate the kinds of duties that may be assigned to its incumbents.  It should not be interpreted as describing all of the duties whose performance may ever be required of such an employee or be used to limit the nature and extent of assignments such individuals may be given.