Authorization Specialist - Care Mgmt
Advantage Behavioral Health Systems
69 reviews
250 Bray St, Athens, GA 30601
Hybrid remote
Full-time
Advantage Behavioral Health Systems
69 reviews
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Job Type
Full-time
Position Summary : Authorization Specialist is responsible for the daily processing of authorization files/requests and coordinates/manages ASO and Care Management Organization (CMO) authorizations for the agency. This position reports to Care Management Director.
Job Responsibilities : Under supervision, incumbent duties and responsibilities will include but is not limited to the following:
• Ensures all behavioral health programs are obtaining and submitting authorizations in a timely fashion.
• Assists with questions or concerns regarding authorizations. Oversees and works on all authorization related issues.
• Conducts training on CMO authorizations, ASO related issues, updates, and eligibility issues.
• Creates reports for managerial staff to summarize errors.
• Oversees the authorization process, makes changes and identifies issues to avoid billing discrepancies.
• Electronically submits, receives, and process data daily. (Batch & Load) Analyzes reports, corrects errors and/or inform appropriate staff of error to be corrected and re-submit.
• Review documentation related to authorization requests and coordinate with program team members to ensure the State and CMO requirements/standards are met.
• Works closely with agency program staff on any requests that are under review.
• Coordinates with the CMD Director and/or service line manager/director regarding any authorization reviews and appeals.
• Use advanced tools to analyze data and conduct comprehensive clerical research using a variety of resources to generate reports and responds to requests.
• Enter data from forms, records, and/or reports using a computer or terminal. Code information as appropriate.
• Triages tickets and/or corrects errors related to authorizations, service codes, documentation, scheduling, appending, updates, etc.
• Attends meetings and represents CMD and agency.
• Works collaboratively with CMD staff, programs, and agency.
• Any other duties and/or projects as assigned.
• Hybrid employees must be available to attend in person meetings, provide support, training, special events, events of connection loss or any other request designated by CMD Director or agency leadership.
Hybrid Remote Position - Must have private homework space, internet connection, childcare during work hours and agree to the terms and conditions outlined in ABHS Policy 1200.302 and agree & sign the agency Telework/Telehealth Information & Agreement.
Entry Qualifications:
Knowledge/Skills/Abilities: Must have excellent verbal and written communication skills. Requires effective customer relation skills, ability to organize and interpret data. Requires good judgment, tact, diplomacy, and ability to problem solve. Able to work effectively in a team environment. Able to use a personal computer and related software.
Skill, Competency and Education Requirements:
• Demonstrate overall knowledge of authorization and claims processing for insurance companies and plans both private and government.
• Demonstrate the ability to make decisions, assess, and resolve problems effectively.
• Demonstrates the ability to maintain the confidentially of all records.
• Demonstrated ability to manage multiple tasks and demands given tight times constraints while ensuring a high degree of accuracy and attention to detail.
• Effective interpersonal skills in a diverse population
• Ability to interpret and apply agency policies and procedures.
• Ability to communicate effectively, both orally and written
• Ability to establish and maintain effective working relationships with others.
• Completion of an associate degree from an accredited college or two years of related experience
• Experience with SFTP protocols, Microsoft Excel- creating spreadsheets, filtering, and pivot tables, Microsoft Word- creating error templates and documentation.
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