Authorization Clinician - Samaritan Hospital

Trinity Health•Troy, NY

3d•Onsite

About The Position

The Authorization Clinician for outpatient is responsible for the tracking and review of those cases requiring telephonic case management. Tracking is accomplished via computer. Pre-authorization and case management is done with reviewers at the Managed Care Organization that is responsible for approving a client's treatment. The Authorization Clinician for inpatient is responsible for managing the authorization process for prospective patients and insurers. This involves determining an appropriate level of care based on established admission criteria; once those determinations are made, presenting the clinical cases to insurers and managed care companies to secure authorizations for admission to treatment at the St. Peters inpatient rehabs. Also responsible for: welcoming and registering incoming patients to rehab, screening prospective clients for placement into the numerous St. Peter's addictions programs & investigating delinquent accounts and securing payment for denials. The Authorization Clinician is instrumental in answering inquiries from referents and persons in the community seeking treatment for substance abuse, providing guidance to appropriate levels of care in the SPARC continuum or other agencies in the community.

Requirements

Bachelor’s degree or Associates degree with a QHP.
One to three years experience in the Behavioral Services field.
Familiarity with PC basics.
Ability to learn new programs.
Strong writing and communication skills.
Knowledge of working with community agencies and managed care representatives.

Nice To Haves

Master's degree in a related field and QHP.
Experience with insurance/managed care organizations.
Experience working with a diverse population.
Strong understanding of multicultural issues.

Responsibilities

Tracking and review of cases requiring telephonic case management.
Pre-authorization and case management with Managed Care Organization reviewers.
Managing the authorization process for prospective patients and insurers.
Determining appropriate level of care based on established admission criteria.
Presenting clinical cases to insurers and managed care companies to secure authorizations.
Welcoming and registering incoming patients to rehab.
Screening prospective clients for placement into St. Peter's addictions programs.
Investigating delinquent accounts and securing payment for denials.
Answering inquiries from referents and persons in the community seeking treatment for substance abuse.
Providing guidance to appropriate levels of care in the SPARC continuum or other agencies in the community.