UM/Data Specialist

Community Service Board of Middle Georgia - PEO, Ltd.•Dublin, GA

10d•Onsite

About The Position

The Community Service Board of Middle Georgia is searching for a Utilization Management (UM)/Data Specialist for the HOPE IC3 Program! The Utilization Management/Data Specialist will be responsible for working cross-functionally with our Utilization Management department to ensure that Medicaid and other authorizations are handled by their appropriate deadlines. LOCATION: Dublin, GA

Requirements

High School Diploma/GED (or equivalent)
Previous experience working with qualitative data and research
Proficiency in Microsoft Office products
Attention to detail and problem-solving skills
High level of professionalism
Strong written and verbal communication skills
Excellent time management & organizational skills

Nice To Haves

Bachelor’s degree in a related field preferred.

Responsibilities

Complete authorization service summaries for C&A, EA and IC3 CMO consumers in a timely manner as additional units are needed or when authorization dates end.
Send CMO OTR summary authorization requests for C&A and EA to B12 UM department for submittal.
Submit GAMMIS for IC3 CMO consumers.
It is required that summaries are completed and submitted before authorization expires or units are out.
For APS Medicaid/FFS/State Contracted consumers an ASO must be completed as additional units are needed or authorization expires. ASOs need to be completed no later than 5 days after additional service is needed.
Will submit ASO’s and provided documents for CMO’s, Medicaid/FFS/State Contracted consumers via GAMMIS for Autism services.
Sill submit ASO’s for Medicaid/FFS/SCS consumers via CareLogic for IC3 services.
Will communicate with UM department B12 immediately via email when receiving an authorization or a denial by phone or email concerning consumers in all programs.
Will check UM reports from Tanika and other UM members to ensure that no insurances have been discontinued or changed. When insurance changes will immediately work toward getting OTRs completed the same day for CMO insured individuals and within 24 hours of cases who require an ASO to be completed.
Will track dates that authorizations are submitted to UM department and notify UM/Program Director/case manager if authorization requests are not answered by CMO/APS within 10 days of request.
Will maintain accurate authorization of unit’s system and will check for accuracy and for need of additional service request summaries on a daily basis.
Will gather summary information needed from case managers/program directors and will develop summaries to be submitted for authorizations. Will ensure that all pertinent information is included on summaries.
Will communicate with manager, program managers and program coordinator when trends or problem arise which hinder the authorizations to be completed.
Will consistently work reports submitted from UM and reports in Avatar as needed, to ensure that authorization issues are resolved and that changes are made to ensure that the billing instances for services rendered have no issues.
Will regularly check payor sites and with UM for any changes affecting authorization for services. Will communicate current information with coordinator, managers, and direct service staff.
Will ensure that all current plans are complete and available prior to requesting authorization for services. Will maintain clear and timely communication with schedulers, managers, and direct service staff regarding any required updates, scheduling needs, or issues that may hinder the authorization process.
Assist managers with assigned projects, data collection and other task as needed.
Participate in LOC meeting and Denial Review meetings as needed.
All other duties as assigned