VOB/UR Specialist

Who We Are:

Symetria Recovery is the #1 outpatient rehab in Illinois and Texas. It started with three simple, yet game-changing core beliefs: Addiction is a disease; co-occurring mental health conditions should be addressed, and patients deserve respect, not judgement. Symetria Recovery provides comprehensive substance abuse treatment with a focus on Medication-Assisted Treatment (MAT) in a welcoming outpatient setting. Unlimited clinical services are available to our patients under our bundled-service delivery model. Key services delivered through our Opioid Treatment Program (OTP) licensure include MAT, medically monitored psychiatric care, individual therapy, group therapy (IOP), 6-day-per-week nursing care, and ongoing aftercare. Most of our patients being provided medication receive Buprenorphine products, but they can also receive Methadone, and any other FDA-approved medication for addiction.

What You Will Do:

The Utilization Review (UR) & Verification of Benefits (VOB) Specialist is responsible for auditing Verifications of Benefits, maintaining electronic health record (EHR) insurance information, and maintaining eligibility checks and authorizations on active clients.

• Reviewing VOB of each admitted client to confirm information is accurate (to include contracted services & Medicare versus Medicare Advantage coverage)
• Updating EHR with any VOB updates or corrections, notifying billing and/or clinic as appropriate
• Effective communication with the VOB partner
• Batch verification of every active client each month and updating EHR, clinic, and billing as appropriate, using designated workflows
• Communicating with clinics and pre-admit teams regarding inquiries about VOBs
• Manages VOB and UR portions of internal insurance change process for existing clients that present new insurance, change insurance services, or change self-pay services
• Submit requests for pre-certification to UR partner
• Review charts for medical necessities, as needed
• Submitting and tracking retro authorization requests, as needed
• Assist with any assigned projects and analysis

Who You Are:

• Ability to work effectively in a constantly changing environment, good judgment, and capable of making decisions with attention to detail
• Excellent organizational skills and ability to prioritize and coordinate workload with high degree of proficiency and accuracy
• Strong analytical and problem-solving skills, with the ability to locate and analyze VOB and UR trends
• Ability to identify network used for INN payors
• Ability to work collaboratively with other departments and inquire about questions or discrepancies when appropriate
• Ability to work independently and follow through on tasks with minimal direct supervision
• Maintains strict confidentiality of patients' medical records and adherence to all HIPAA and 42 CFR Part 2 laws and regulations
• Proficiency in Microsoft Office
• Excellent interpersonal communication skills
• History of working with insurance in substance abuse and behavioral health treatment, with preference for 2+ years' experience

Benefits Available to You:

• Medical, dental, and vision insurance for you and your family
• 401(k) with company match
• Life insurance
• Pet insurance
• CEU reimbursement and paid time for continuing education
• Licensure fee reimbursement
• Paid vacation and sick time
• Closed and paid major holidays

Compensation for this position is based on market analysis and will be determined by additional factors such as location/state, skills, years of experience, relevant credentials, and education. The posted compensation range for this role is $55,000 to $65,000 annually. We are committed to offering a competitive compensation and benefits package that reflects all the factors previously outlined in conjunction with current market trends.

Come join a team that believes in and has a passion for providing personalized care to each individual that is a part of Symetria Recovery!