Mental Health Care Planner

Essential Duties and Responsibilities 

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. 

• Obtains patient demographic and health insurance information: collects co-pay(s) when appropriate.  


• Verifies and records insurance benefits, with the ability to understand and provide insurance     breakdowns. 


• Obtains prior authorization if required by payer(s). 


• Interacts professionally with LCSW's, Case Managers, RT’s, PCC’s, Viemed Staff, patients, patient's family, and co-workers. 


• Schedules referral appointments, as called into VCS, by LCSW's, per policy and procedure. 


• Retrieves incoming referral(s) and logs demographic information into current patient database & billing system. 


• Assigns patients to case managers and social workers according to nee 


• Reviews medical records from referral(s) to determine if medical necessity has been met. 


• Communicates to administrative staff&/or referral source(s), if referral is acceptable or what is missing to complete referral(s). 


• Documents in computer system the status of referral. 


• Reports all concerns or issues directly to VCS Manager, Supervisor, Lead, or VCS Planner  


• Creates Smartsheet and Excel reports to track referrals, SW/CM task completions. 


• Maintains credentialing of VCS program with Behavioral Health Insurance Companies including applying for company credentialing, LCSW individual credentialing, managing Smartsheet to track when licensures are for renewal and addressing any communications sent by the Insurance companies.  


• Other responsibilities and projects as assigned. 

Qualifications 

• High School Diploma or equivalent One ( I ) to two (2) years working for a Durable Medical Equipment company Mental Health or relevant medical office experience preferred. 


• Basic understandings of medical insurance benefits. 


• Skill in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public. 


• Effectively communicate with social workers, patients, insurers, colleagues, and staff Able to read and understand medical documentation effectively. 


• Knowledge and understanding of same and similar DME equipment. 


• Knowledge and understanding of In-network vs Out of Network, PPO, HMO 


• Thorough understanding and maintaining of medical insurances company's regulations and requirements to include but not limited to Medicare and Medicaid. 


• Working knowledge of CPT, 'HCPCS & ICDI O codes, MCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits. 


• Learns and maintains knowledge of current patient database & billing system as well as Therapy Notes (VCS Digital Records) 


• Up to date with health information technologies and applications 


• Answers telephone in a polite and professional manner. Communicates information to appropriate personnel and management in a timely manner. 


• Establishes and maintains effective communication and good working relationships with co-workers, patients, organizations and the public. 


• Proficient in Microsoft Office, including Outlook, Word, Bonafide, Therapy Notes, Smartsheets and Excel. 


• Utilizes initiative, strives to maintain steady level of productivity and is self-motivated. 


• Work week is Monday through Friday and candidates will work an agreed upon hours otherwise.      Possible weekend work or overtime, to include as needed. 

Access to Protected Health Information (PHI) 

This position will require the employee to handle Protected Health Information (PHI) for duties related to document and report preparation. Policies and procedures will be strictly adhered to make sure PHI is protected as required by the HIPAA Privacy Rule. 

Working Conditions 

This position will work in an office environment. 

You will be expected to work during normal business hours, which are Monday through Friday, 8:00 a.m. — 5:00 p,m. Please note this job description is not designed to cover and/or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties and responsibilities may change at any time with or without notice.