Rosecrance Behavioral Health

Manager

• Provides mental health rehabilitation services and supports adults and families to decrease hospitalization and crisis episodes and to increase community functioning in order for the client to achieve rehabilitative, resiliency and recovery goals.
• Provide continuity of program services in an ethical, legal and moral manner within a safe and therapeutic environment, consistent with applicable regulatory and accreditation standards.
• Participate as a team member in the delivery of mental health services to clients and their families and facilitate the issues of recovery into their daily living situations.

Case Manager

Claims Specialist

• Review and process all BC/BS and Commercial high dollar claims (over $10,000) for denials, payor issues and payment trends.
• Submit, process and track all appeals for BC/BS and commercial payors. Maintain knowledge of ERISA laws governing employee benefit plans and manage the appeal process for these claims.
• Assist A/R staff with complex claim issues they are unable to resolve in a timely manner.
• Track and trend all Single Case Agreements. Work closely with Contracting on any SCA payment issues / concerns.
• Review payments for BC/BS and commercial payors for rate validation according to our contracts.
• Track all denial outcomes for payment, write-offs and transfers to client liability. Identify the root cause for the adjustments to client accounts. Work with management to review adjustment trends and identify potential solutions.
• Help maintain integrity of accounts receivable ledger, including aged receivable monitoring on an ongoing basis.
• Responsible for maintaining current knowledge of revenue components including benefit plans, contract terms and rates and billing forms and codes.
• Check status of claims through use of telephone, websites and/or other means available.
• Document adjustments needed to patient accounts.
• As needed, participate in phone conference calls with payors.
• Pursue collection activities and follow up for balances outside of established norms.
• Coordinate collection activities with outside agencies, including court appearances, as needed.
• Provide feedback & education management with regards to issues that impact revenue flow.
• Provide appropriate documentation and reports designed to assist in fiscal management of the agency.
• Serve as a member of the SWAT Team and participate in team meetings.
• Serve as a member of the Revenue Cycle Team and participate in all team meetings and activities.
• Understand and comply with all of the principles established by the Rosecrance Corporate Compliance Program and Code of Ethics.
• Perform all responsibilities in compliance with the mission, vision, values and expectations of Rosecrance.
• Deliver exceptional customer service consistently to every customer.
• Serve as a role model for other staff, clients and customers and demonstrate positive guest relations in representing Rosecrance.
• Assume other related responsibilities as assigned by management.

Senior Insurance Claims Specialist

Counselor

• Work hours prescribed by leadership and any additional hours deemed necessary for the responsibilities assigned. Some flexibility may be required for accomplishment of responsibilities.
• Conduct assessments of callers in crisis to determine the severity of the situation, including potential risks to their safety
• Provide immediate and appropriate crisis intervention, using de-escalation techniques to reduce emotional distress and promote safety.
• Document client information and interactions in an Electronic Health Record
• Employ active listening techniques to create a safe and supporting environment where callers feel heard, understood, and validated.
• Conduct a seamless transition of caller to Mobile Crisis Response counselors, providing the team with geographic details, presenting issues, mental health status and other details
• Identify and connect callers to relevant community resources, mental health services, or emergency services as necessary
• Facilitate the seamless transition of care when needed, ensuring that the caller receives ongoing support, and that all relevant information is shared to maintain continuity.
• Work with callers to develop safety plans when necessary, including coping strategies, emergency contacts, and steps to mitigate immediate risks.
• Contact emergency services or healthcare providers when a caller’s safety is at risk and a higher level of intervention is required.
• Monitor Mobile Crisis Response staff availability across assigned location and dispatch counselors based on their availability and geographic proximity.
• Understand and comply with the principles established by the Rosecrance Corporate Compliance Program and Code of Conduct.
• Perform all responsibilities in compliance with the mission, vision, values, and expectations of Rosecrance.
• Able to provide culturally competent and exceptional customer service consistently to every customer.
• Serve as a role model for other staff, clients and customers and demonstrate positive guest relations in representing Rosecrance.
• Assume other related duties as assigned by leadership.

Case Manager

Senior Insurance Claims Specialist

Crisis Access Counselor – 3rd Shift