PAR Writer

PAR Specialist/PAR Writer position description: Under the direct supervision of the Clinical Director, and in collaboration with the Clinical Team, this position is the key to the financial success of the organization. Working with the Case Managers, Clinicians and Nurses, this position will assist in connecting the patient to the continuum of care for the patients treated in several components of care within the company. This role is intended to be the connection to the insurance companies, providers, services and billing for those in treatment with mental health and/or substance use disorders.
This position requires advanced knowledge of billing processes, management of resources, and attention to detail, although a Bachelor's degree is required. Previous work in a behavioral healthcare setting or in similar Prior Authorization positions in a medical setting, is preferred. This position must embody the vision of the agency and must be helpful with staff and patients. A person may qualify for this position with an equal combination of education and experience, and will operate under the guidance of those with the proper degree and/or licensure/ certification. All personnel must pass a background check and not be convicted of any prohibited offenses per the Nevada Revised Statutes (NRS) 449.4329- NRS 449.4332.
1. Murder, voluntary manslaughter or mayhem
2. Assault with intent to kill or to commit sexual assault or mayhem
3. Sexual assault, statutory sexual seduction, incest, lewdness or indecent exposure, or any other sexually related crime that is punished as a felony
4. Prostitution, solicitation, lewdness or indecent exposure, or any other sexually related crime that is punished as a misdemeanor, if the conviction occurred within the immediately preceding 7 years
5. Abuse or neglect of a child or contributory delinquency
6. A violation of any federal or state law regulating the possession, distribution or use of any controlled substance or any dangerous drug as defined in chapter 454 of NRS, within the past 7 years
7. A violation of any provision of NRS 200.5099 or 200.50995 abuse or neglect of an older or vulnerable person
8. Any offense involving fraud, theft, embezzlement, burglary, robbery, fraudulent conversion or misappropriation of property, within the immediately preceding 7 years or
9. Any other felony involving the use of a firearm or other deadly weapon, within the immediately preceding 7 years. Therapy/IOP PARS
1. Verify insurance to make sure it is active/current.
2. Review the spreadsheet of all clients seen by therapists, for the past week on a weekly basis.
3. Track sessions on spreadsheet and compare them to allowed sessions per service limitations for all health plans-weekly (for therapy PARs).
4. Contact therapist when sessions are about to reach their limit to request needed documentation for concurrent authorization requests.
5. Write PAR and have the Clinical Director (or RMH Manager in the absence of the Clinical Director) sign them prior to submitting to the health plan.
6. Write PAR for IOP (intensive outpatient) Therapy services and submit it on the health plan portals. Fax when necessary.
7. Upload/Index the PAR submission, approval or denial to the client's chart.
8. Update tracking sheet when auth approval or denials are received.
9. Inform the RMH Manager and therapist of PAR approval or denial. RMH PARs 1. Verify insurance to make sure it is active/current.
2. Complete RMH PAR's for all health plans.
3. Have the RMH Manager or Clinical Director (in the absence of the RMH Manager) sign the request.
4. Submit completed PAR through health plan portal. Fax if needed.
5. Upload/Index the PAR submission, approval or denial to the client's chart.
6. Inform the RMH Manager and therapist of PAR approval or denial. Housing PARs (if assigned)
1. Check housing PAR request tracker for initial and concurrent PARs indicated, every Tuesday and Friday for added requests that require a PAR.
2. Review the charts and write clinical snapshots in conjunction with the Therapists.
3. If there are no additional clients added to the tracker, the PAR Specialists will reach out to the Case Management Leads to ensure that it is correct and there are no needs for PARs as of this time.
4. Once new names are added, send emails with approved names to the Director of Housing and housing/case management team..