Authorization Specialist

Claratel Behavioral Health • Decatur, GA

4d

About The Position

The Authorization Specialist will be responsible for the daily processing of all authorization files/requests on a daily basis. Works closely with each clinician on any requests that are on review. Ensures all behavioral health programs are obtaining and submitting authorizations in a timely fashion. Assists clinicians with questions or concerns they may have regarding authorizations. Oversees and works on all authorization related issues. Conducts training on CMO authorizations, ASO related issues, coding/billing updates and eligibility issues. Creates reports for managerial staff to summarize errors. DUTIES & RESPONSIBILITIES: Under general supervision, incumbent duties and responsibilities will include but is not limited to the following: Coordinate/manage all ASO and Care Management Organization (CMO) authorization requests for DeKalb CSB Oversees the authorization process end to end making changes as identified and resolving of billing discrepancies Electronically submits, receives, and process data on a daily basic. Analyzes reports and correct errors and/or inform appropriate staff of error to be corrected and re-submit Review documentation and coordinate with clinical team members to ensure the State and CMO clinical requirements/standards are being met Coordinate with the UM Manager 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

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’s 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

Responsibilities

• Coordinate/manage all ASO and Care Management Organization (CMO) authorization requests for DeKalb CSB
• Oversees the authorization process end to end making changes as identified and resolving of billing discrepancies
• Electronically submits, receives, and process data on a daily basic. Analyzes reports and correct errors and/or inform appropriate staff of error to be corrected and re-submit
• Review documentation and coordinate with clinical team members to ensure the State and CMO clinical requirements/standards are being met
• Coordinate with the UM Manager 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree