79086BRJob Posting Title:Psychiatry Resource Specialist - 40 hours (remote)Department:Patient Services-NursingAutoReqId:79086BRStatus:Full-TimeStandard Hours per Week:40 Job Posting Category:NursingJob Posting Description: This Resource Specialist will be responsible for:

• Working directly with our clinical teams, commercial and government payers, state agencies, behavioral health facilities, community based behavioral health providers and programs to help move patients through the continuum of care safely and efficiently.

• Collaborating and communicating with multidisciplinary team members and external resources to facilitate psychiatric level-of-care disposition as determined by the clinical team.

• Completing psychiatric discharge planning tasks including bed searches, partial hospitalization intake referrals, in-home therapy referrals, psychiatric inpatient, CBAT (Community Based Acute Treatment), residential admissions and specialized clinic referrals.

• Assessing, via electronic systems, patient’s insurance plans and benefits, such as MassHealth eligibility.

• Completing documentation of work in the electronic medical record.

• Serving as a resource for families and Psychiatry clinicians in regards to insurance eligibility, coverage, benefits, and provider networks.

• Participating in all areas of Resource Specialist and departmental hand-off in order to maintain seamless coordination of care.

• Communicating with psychiatry clinicians, all that needs to be shared with patients and/or family members regarding resources, insurance coverage and payment and other general information.

• May represent the Resource Specialist Team on committees, projects and meetings relevant to the behavioral health population.

• Securing initial authorizations in accordance with payer rules for BCH bedded psych units as well as external behavioral health facilities.

• Reviewing clinical documentation to ensure it justifies appropriate level of care prior to submission to payers; can provide verbal presentations to payers if required.

• Providing updated clinical documentation to payers for BCH boarder authorizations.

• Serving as primary contact for payers and select state agencies to expedite discharges.

• Working remote; Monday - Friday, 8:30-5:00.

  To qualify, you must have:

• 1 year of experience in a patient contact healthcare setting required. Experience in a behavioral health environment preferred.

• Analytical skills to resolve problems that require the use of basic scientific, mathematical, or technical principles

• The ability to communicate effectively both orally and in writing and provide empathy in difficult interpersonal situations

• Ability to effectively coordinate discharge activities with the assigned unit/team.

• Ability to maintain a working knowledge of insurance plans.

• Knowledge of medical terminology and experience with Electronic Medical Record.

• Familiarity with behavioral health continuum of care.

• Ability to identify, locate and effectively utilize resources including databases, websites, references materials and libraries to obtain information.

Office/Site Location:WalthamRegular, Temporary, Per Diem:Regular Remote Eligibility :Full-Time Remote