HEALTH CARE INSURANCE SPECIALIST at Bethany Children s Home – Womelsdorf, Pennsylvania
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About This Position
BETHANY CHILDREN’S HOME
Program and Position Summary
PROGRAM SUMMARY
Bethany Children’s Home provides individualized services to youth between the ages of 6 and 20 in a residential home setting on our beautiful rural campus located in Womelsdorf. Youth have opportunities to participate in a variety of therapeutic, spiritual, recreational and cultural services while they heal from past traumas.
EXPECTED STANDARDS FOR ALL BETHANY TEAM MEMBERS
All Bethany Team Members must be at least 21 years of age with a high school diploma or equivalent and be prepared to meet the diverse needs, level of care, supervision, safety, and wellbeing of youth in Bethany’s service. All Team Members share in the responsibility of upholding Department of Human Services Regulations and Bethany program expectations including:
- Adhering to all policies and procedures.
- Performing all expected work responsibilities in a safe manner.
- Treating all children, families and Team Members with respect and courtesy.
- Completing and maintaining all mandated and required training within required agency timeframes.
- Maintaining timely compliance with all established agency standards and employment documentation.
- Acting in compliance with Department of Human Services regulations to the highest degree of ethical standards.
- Maintaining a clean, safe and functional working environment.
- Providing services in a manner that are sensitive to the age, culture, religion, dietary needs, sexual orientation, gender identity and other important individual needs of those in our service.
- Ensuring proper physical care is provided to those in our service.
- Ensuring new clothing and personal grooming items are provided.
- Implementing strategies to discourage runaways and unauthorized absences.
- Informing all youth of his/her rights and ensuring that those rights are obtained.
- Carrying out the program’s rules and conduct standards with a positive, strength-based behavior management approach.
- Providing transportation to and from campus appointments.
- Performing additional duties as assigned by supervisor or administrator per operational needs.
- Functions as a team and implements programmatically/socially desirable standards that represent the mission and vision of Bethany Children’s Home.
ELEMENTS OF PERFORMANCE
Bethany programs serve an at-risk population referred by county Children and Youth Services or Juvenile Probation. Children and youth served may have experienced trauma, abuse, neglect, exposure to addictive substances and trafficking. Team Members, as a collective whole, are expected to have working knowledge of how to address such individuals directly and assist them through treatment, or refer them to someone who is qualified. Team Members are expected to have the knowledge and skills to recognize, treat or refer to appropriate professionals the following:
- Abide by mandated reporting requirements.
- Systematically gather data, determine the readiness of an individual for treatment and change, apply accepted criteria for the diagnosis of substance use disorder or other detrimental addictions or behaviors.
- Recognize when a youth is under the influence of a psychoactive substance, intoxicated, and/or experiencing withdrawal symptoms.
- Monitor for danger to self or others.
- Document mental health concerns.
- Analyze and interpret data to determine treatment recommendations and priorities.
- Form mutually agreed-upon, measurable goals and objectives with the individual being served.
- Demonstrate and adhere to the accepted ethical and behavioral standard of conduct.
- Participate in continuing professional development.
MINIMUM QUALIFICATIONS FOR ALL BETHANY TEAM MEMBERS
- Be 21 years of age or older.
- Be fluent in the language(s) spoken by a majority of the youth in care.
- Have acceptable written and verbal communication skills.
- Have acceptable organizational and computer skills.
- Demonstrate acceptable interpersonal and problem-solving skills.
- Possess a strong commitment to helping youth succeed by helping them reorient their lives, nurture their reunification efforts and enable them to make a successful transition to their next placement.
- Possess ability to establish rapport and relate sensitively with consistency to multiracial and multicultural groups of young adults.
- Demonstrate the ability to organize and prioritize duties and responsibilities efficiently.
- Possess a valid Pennsylvania Driver’s License with a clear 3-year driving history.
- Successfully pass a pre-employment drug screen and background check.
- Submit to a health assessment demonstrating fitness for duty, certified by a physician no more than 30 days prior to commencing employment and comply with a two-year renewal.
- Provide current PA Child Abuse, PA Criminal History and FBI Fingerprinting clearances prior to commencing employment and comply with a two-year renewal.
SAFETY HAZARDS OF THE JOB
- Potential for possible exposure to bloodborne pathogens – universal precautions are to be utilized in all potential exposure situations.
- Potential for emotional stress and vicarious trauma as it relates to working with children and youth.
- Potential for personal injury that may include, but not limited to, bites, kicks, punches and scratches.
HIPAA /CONFIDENTIALITY
As an employee, Bethany Team Members must agree to follow the standards set forth by the Health Information Portability and Accounting Act (HIPAA) as well as the heightened Pennsylvania standards as they apply. Due to the nature of the work environment, Team Members will have direct and/or indirect access to confidential information regarding clients and/or personnel. All confidential information cannot be discussed with, or disclosed to, unauthorized persons.
EMPLOYER'S RIGHTS
The program summary and position description do not list every aspect of program requirements or all duties of all job positions. All Team Members are employees of Bethany Children’s Home—not necessarily to a specific department or program, with the exception of those roles requiring specific credentials to be in compliance with regulations and treatment services. Team Members may be asked by Bethany to perform other duties within those expectations in times of emergency, crisis or busier times based on operational needs in order to safely care for youth. Performance evaluations, in part, will be based upon performance of the tasks and essential functions listed in the position description.
Bethany has the right to revise the program summary and position description at any time. The position description is not a contract for employment. That is, employment with Bethany can be terminated with or without cause, and with or without notice at any time, at the discretion of the employee or that of Bethany.
POSITION DESCRIPTION
Position Title: Health Care Insurance Specialist
Classification: Regular, Full-Time, Hourly – Non-Exempt
Reports To: Director of Compliance
Supervises: N/A
Essential Staff? No
POSITION SUMMARYThe Health Care & Insurance Specialist (HCIS) engages in research for insurance regulatory credentialing to be eligible with medical, dental, and vision carriers. Once criteria of acceptance to insurance boards and approval is established, the HCIS will track youth insurance coverages, request pre-authorizations as deemed necessary, and file claims in accordance with the carrier procedures. The HCIS will communicate with external health care providers to obtain individual medical information and provide necessary information for prescribed treatment. The HCIS also conducts record audits, medication cart audits, and medication administration.
PRIMARY RESPONSIBILITIES- Obtain the regulatory criteria for participating medical, dental, vision insurance carriers to gain credentialing status to receive funding for providing medical/health services.
- Once credentialed with insurance carriers, establish the claim submission process and file claims for services provided.
- Checking all new intakes insurance and providing the information to the necessary parties.
- Audit and inspect medical records along with medication carts in all programs.
- Audit Medication Administration Records
- Prepare required encounter forms for psychiatric appointments and submit for billing.
- Upload any monthly medication administration records to electronic health record.
- Review all pharmacy bills along with outpatient providers.
- Monitor claim process for payments, denials, and necessary authorizations.
- Facilitates the credentialing of new insurance companies under the direction of department leadership.
- Facilitates the credentialing of therapists under the direction of department leadership.
- Obtains medication administration certification to provide support for administering medications.
- Responsible for maintaining compliance with all training requirements of Bethany and DPW.
- Participates in regular supervision with direct supervisor.
- Maintains accurate recordkeeping as assigned by the department supervisor.
- Obtain authorizations for pharmacy.
- Obtain out-of-network authorizations through insurance companies.
REQUIRED COMPETENCIES
- Proven history of knowledge related to the health care industry.
- Knowledge of insurance practices, credentialing and claims processes.
- Performs primarily light work in a climate-controlled office environment.
- Must be able to perform the physical requirements of the position:
- Remain in a stationary, seated position more than 50% of the time.
- Occasionally perform light work by lifting, carrying, pushing, pulling up to 20 pounds without assistance.
- Move about on foot to complete tasks and move from one location to another.
- Respond to crises as needed
- Able to travel throughout campus to visit cottages for team meetings
- Stoop, kneel, crouch, reach, climb stairs, and stand regularly.
- Have close visual acuity to prepare and analyze figures and data, to view a computer monitor and operate typical office equipment.
- Have manual dexterity to grasp and manipulate objects.
- Be subjected to occasional noise that would cause one to shout in order to be heard above ambient noise level.
- Be able to respond to crisis situation and participate in physical interventions and tolerate prolonged periods of physical exertion which may include exhaustion.
- Demonstrates a commitment to achieving a standard of excellence with procedures and outcomes.
- Communicates effectively by balancing listening and talking, speaking and writing clearly and influencing others.
- Demonstrates excellent teamwork skills by being helpful, accountable, respectful and approachable.