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Company Name : PO’AILANI, INC.
Location : Kaneohe, HI 96744
Position : Utilization Specialist
Job Description : Job SummaryPo’ailani, Inc. is seeking a Utilization Specialist, Full-Time, for our Adult Dual Diagnosis Treatment Facility. Applicants must be available to work Monday – Friday, 40 hours per week.BenefitsMedical / Dental / VisionGuardian Supplemental Insurance401(k)Paid Vacation BenefitsPaid Sick BenefitsPaid Bereavement BenefitsPaid Holiday BenefitsQualificationsMinimum High School DiplomaFamiliar with managed care systemsFamiliar with medical billing and billing codesFamiliar with substance abuse and mental health terminologyExcellent computer skills – Microsoft Office (Word, Excel), QuickBooks, State Websites/WITSAble to learn various systems quickly and efficientlyStrong organizational, time management, verbal and written communication skillsMust pass a criminal background checkJob Duties & ResponsibilitiesServices provided by the Utilization Specialist include but are not limited to the following:Confirms insurance eligibility and benefitsResponsible for obtaining prior authorizations from insurance funders for patients being admitted into various programs and throughout patients stay.Verifies coverage via phone, fax, email, websites, etc.Resolves any issues with insurance coverage and authorizations dailyCompletes all necessary paperwork to ensure authorizations are obtained from the various insurance funders.Coordinates and communicates daily with clinicians and billing staff ensuring all required documentation is completed accurately and communicates any changes to insurance.Coordinates and completes appeal letters upon denials or unpaid claimsProcess authorizations, assists in preparing billing for all funding sources (Managed Care and Department of Health).Payment reconciliation and assist in posting into QuickBooks as neededResponds to various external and internal inquires timely via email, fax, phone calls, etc.Assist the Chief Financial Officer with various accounting duties and filing paperworkAssist in answering phone calls and providing excellent customer serviceMust be able to work in a fast-paced working environmentOn-going training is providedJob Type: Full-timePay: From $15.00 per hourBenefits:401(k)Dental insuranceHealth insurancePaid time offVision insuranceSchedule:8 hour shiftDay shiftMonday to FridayEducation:High school or equivalent (Required)Experience:Insurance verification: 1 year (Preferred)Medical billing: 1 year (Preferred)Work Location: One location
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