Service Authorization Contract Analyst

Virginia Information Technologies Agency•Richmond, VA

1d•Hybrid

About The Position

The Department of Medical Assistance Services (DMAS) is offering a competitive opportunity to serve as the Service Authorization Contract Analyst in the Program Operations Division. This position supports the service authorization (Srv Auth) contract monitoring process by working with a team of contract monitors and service authorization specialists to determine the service authorization contractor's compliance with all aspects of the service authorization contract. Special emphasis is placed on assisting with the review of determinations for Traditional Services, Non-Traditional Services, and some Behavioral Health Services, including appeal summaries as needed, and problem resolution from providers, members, constituents, and the service authorization contractor. The role also involves working with Behavioral Health service authorization services. The service authorization contract is large and multi-faceted, encompassing IM systems and clinical decision-making. This position has in-office requirements, including attending in-person meetings and training. Located in Central Virginia, the Richmond area offers proximity to the Blue Ridge Mountains, Virginia Beach, and Washington D.C. DMAS is dedicated to improving the health and well-being of Virginians through access to high-quality healthcare coverage and seeks talented individuals who align with the agency's mission and core values: service, collaboration, trust, problem-solving, and adaptability.

Requirements

Considerable knowledge/experience of health care needs of individuals from birth to end stage with various diagnoses and medical health issues.
Considerable knowledge/experience in medical standards of practice as they relate to medical diagnoses of members.
Considerable knowledge/experience monitoring, auditing, and working with contractors, to include analyzing data to resolve problems.
Considerable knowledge/experience using nationally recognized clinical guidelines for program development/planning/implementation.
Considerable knowledge/experience in using Microsoft Products, including Word, Excel, etc. and the use of databases.
Knowledge/Experience with interpretation and application of federal, state laws/regulations.
Experience in meeting deadlines.
Experience with internal/external stakeholders.

Nice To Haves

Knowledge of medical necessity guidelines/criteria.
Knowledge of UM (utilization management) processes.

Responsibilities

Providing support to the service authorization (Srv Auth) contract monitoring process.
Working with a team of contract monitors and service authorization specialists in determining the service authorization contractor's compliance with all aspects of the service authorization contract.
Assisting with review of determinations for Traditional Services, Non-Traditional Services and some Behavioral Health Services, including appeal summaries as needed.
Problem resolution from providers, members, constituents and the service authorization contractor.
Working with the Behavioral Health service authorization services.
Attending in-person meetings and training.