Who We Are at Virgil
Virgil is a tech-forward provider of adult behavioral therapy across the United States. We believe that patients, clinicians, and insurers all deserve a better healthcare experience, so we built one.
Our mission is to provide personalized, technology-empowered care for adults struggling with behavioral disorders in the environment best suited to help them - their home or ours.
We're looking to rapidly grow our team with values-driven, diverse, caring professionals to help us.
About The Role
VIrgil is hiring a UR Specialist to own the SCA (single case agreements) process. This role works across different levels of care for behavioral health in a fast paced, technology driven environment.
This position involves a high level of collaboration and is cross functional in nature, which will give the opportunity to collaborate with internal medical, clinical and primary therapist teams. You will assist with systems and analyze data related to length of stay and days authorized by specific insurance companies.
- Determine client medical necessity for insurance claims using various criteria and dimensions as set by the insurance carriers
- Work closely with treatment team and admissions staff in clinical determination of clients to help decide their best level of care
- Conduct chart reviews to ensure clinical documentation matches level of care requested
- Ensure that authorizations are accurate and properly recorded (eg. correct authorization number, LOC , facility, number of days and date range)
- Work with DSM V diagnosis ICD 10 codes and ASAM criteria and dimensions for all levels of care
- File appeals for denied cases and follow through on that process
- Maintain timely, accurate and organized documentation and record keeping
- Demonstrate the ability to act as a team player in a positive and professional manner
- Work with in-network and out-of-network benefits to help maximize patient days
Education & Experience:
- Minimum two years of experience with obtaining authorization for adolescents and adults
- Experience working with detox, residential treatment, PHP, and IOP level of care
- Must have successful experience obtaining single case agreements with EPOs, HMOs, and PPOs
- Experience working with out of network PPO insurance
- Experience with quality assurance audits
- Familiarity with the appeals and retrospective authorization process
- Working knowledge of programming/clinical requirements for the major health plans (Optum, Anthem, Cigna, BCBS, etc.)
- Knowledge of ASAM criteria
- Experience in a facility is preferred
- Peer to peer experience is a plus
- Utilization review: 3 years (Preferred)
- Chart Auditing: 2 years (Preferred)
In addition to our clinicians and supporting departments, our company is built around four cross functional teams (spanning operations, product, marketing, business development, etc.):
- Demand - Deliver top notch products and services to our growing number of patients. You'll work with patients to understand pain points and optimize the patient journey from first contact to start of care to offboarding.
- Supply - Own and manage the relationship with our clinical practitioners. You are responsible for the growth of our clinician ecosystem by attracting, recruiting, and retaining high quality behavioral care providers.
- Platform - Build tools and provide services to optimize and improve the delivery of clinical care. You'll help match the right provider with the right family, coordinate clinical care, and develop digital therapeutics products.
- Quality - Improve the quality of care delivered to our patients. You'll ensure that we provide strong clinical outcomes, develop training platforms to level up our providers, and maintain compliance with a variety of payor and regulatory requirements.
At Virgil, we are a globally distributed team with many of our team members located in the following cities: San Francisco, New York, Los Angeles, Toronto, Montreal, and Kyiv. While everyone currently works remotely, we envision a future that balances face to face collaboration with a remote friendly environment.
The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required for the position.
Virgil is an equal opportunity employer that is committed to providing all employees with a work environment free of discrimination and harassment. We celebrate diversity and welcome applicants from every background and life experience.