Payment Recovery Specialist is responsible for analysis of denied reimbursement claims. Ensures appropriate insurance coverage for compliance standards and revenue generation. Being a Payment Recovery Specialist monitors, evaluates, and reviews all cost reporting in support of claims. Coordinates with departments and insurance companies to correct errors as necessary. Additionally, Payment Recovery Specialist requires a bachelor's degree in area of specialty. Typically reports to a supervisor or manager. To be a Payment Recovery Specialist typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)
SCOPE OF POSITION:
Serve as a recovery agent by providing and advocating for any effective recovery-based services that will aid the individual in daily living. Involves a variety of routine, standardized tasks that is performed by the peer recovery specialist based on training and lived experience which includes the promotion of recovery, and encourages and provides community socialization, self-advocacy, self-help, role modeling, resource brokering, cheer leading, and development of natural supports. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence Accountability, Respect and Teamwork.
ESSENTIAL JOB FUNCTIONS:
1. Work with referral sources to identify individuals in need of peer recovery support.
2. Assist individuals in creating personal goals for recovery, career, and/or educational action plans.
3. Support individuals in identifying and creating personal goals and developing recovery plans with the skills, strengths, supports, and resources to aid them in achieving those goals.
4. Assist individuals in working with their referral source, case manager or treatment team in determining the steps he/she needs to take in order to achieve these goals and self-directed recovery.
5. Assist individuals in, locating and joining existing self-help (mutual support).
6. Utilize tools such as the Recovery Action Planning to assist individuals in creating their own individual recovery action plans.
7. Utilize and demonstrate problem solving techniques with individuals and groups; discussions will be utilized where individuals will share common problems and solutions.
8. Use ongoing individual and group sessions to communicate to individuals how to identify and combat negative self-talk and how to identify and overcome fears by providing a forum which allows group members to share their experiences.
9. Assist the individual in obtaining decent and affordable housing of his/her choice in the most integrated, independent and least intrusive or restrictive environment.
10. Support individuals’ vocational choices and assist them in applying for and choosing a job that matches their strengths, overcoming job-related anxiety by reviewing job applications, and providing interview tips and encouragement.
11. Assist individuals in building social skills in the community through participation in community activities.
12. Assist individuals in developing empowerment skills and combating stigma through self-advocacy. This will be accomplished through regular meetings, individual or group sessions.
13. Work with the individuals and other treatment team staff to develop a treatment/recovery plan based on the individual’s needs and identified goals.
14. Collaborate with the individual and/or a treatment team, if applicable in documenting the following on the peer’s treatment/recovery plan:
a. Identifying goals
b. Collaborate treatment planning
c. Life skills coaching
d. Resource referral
e. Conducting recovery groups
f. Assisting with discharge planning (navigating needs in the community, housing, court calls, etc.)
g. Individual peer sessions (one-on-one)
15. Assist individuals in building social skills in the community that will enhance job acquisition and tenure.
16. Adhere to format, content and corporate style guidelines as well as academic styles, giving consideration to usability and ensuring accuracy, consistency and quality.
17. Attend local/state meetings/trainings as directed.
18. Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
19. Additional duties as assigned.
KNOWLEDGE, SKILLS, AND ABILITIES:
Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices):
Mobility, reaching, bending, lifting, grasping, ability to read and write ability to communicate with personnel, ability to remain calm under stress. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.
EDUCATION:
Required: High School education or equivalent. Actively in recovery with a minimum two years of demonstrated personal recovery.
Preferred: Associates degree or higher in relevant field. Department of Human Services Certified Peer Recovery Support Specialist with the State of Arkansas
EXPERIENCE:
Required: In active recovery with a minimum of two years demonstrated personal recovery
INTERNET REQUIREMENTS:
Reliable, high-speed wireless internet service (Wi-Fi)
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