POSITION SUMMARY:

Responsible for completing concurrent reviews for continued authorization and entry of authorizations into Avatar in a timely fashion. Responsible for assisting management with denial recoupment and appeal. Maintains accurate documentation to reflect all contacts made. Responsible for continued coverage verification. Reports to and functions under the direction, instruction, and supervision of the Provider Services & Baker Act Office Supervisor.

QUALIFICATIONS:

Bachelor's degree from an accredited college or university, plus one year experience in a related field. Needs to be able to read and write proficiently, needs to be able to utilize Microsoft Word, Excel, Outlook, Power Point & Avatar.

PHYSICAL DEMANDS:

Abilities in reaching, bending, talking, , sitting, carrying, standing, grasping, fine hand coordination, ability to read and write, and the ability to remain calm under stress. Ability to reach with hands and arms, climb stairs, balance, stoop, kneel, crouch or crawl. Must be capable of lifting 20 pounds alone.

WORK ENVIRONMENT:

General office, health care setting. Most work completed while seated at desk using standard office equipment. Fast paced team approach. Multi-tasking ability requires above average time management skills.

FUNCTIONAL RESPONSIBILITIES INCLUDE:

• Tracks authorizations and conducts reviews of patient care with consumer's insurance companies &/or DCF/CFBHN, as indicated by job assignments, before or on next due date.
• Compiles necessary and requested data to manager, supervisor, and other departments as assigned or requested.
• Assists in appeals process for denied authorization and claims.
• Provides discharge information to close out the case and finalize the authorization.
• Timely and accurate entry of all contact with managed care companies into UM tracking form on Avatar (inpatient) or tracking log (outpatient).
• Verifies funding at the beginning of each month for all consumers on case load. Enter/update financial eligibility screen as needed.
• Maintains good communication with other managed care staff, as well as programs providing service(s), regarding funding & authorization issues.

COMPLIANCE RESPONSIBILITIES INCLUDE:

• Adheres to all applicable federal, state, local, and company maintained standards of compliance, ethics, and policies concerned with the administration and delivery of agency services.
• Meets deadlines, requirements, and expectations as established by the supervisor, agency and department.
• Completes administrative functions and data entry timely and accurately.

CUSTOMER SERVICE RESPONSIBILITIES INCLUDE:

• Provides exceptional customer service in all communications and interactions with staff, general public.
• Maintains confidentiality and remains calm under stress.
• Assists staff with support in all areas of functional responsibility in a courteous, supportive manner.
• Maintains and exhibits servant leadership qualities and exceeds customers' expectations.

FISCAL RESPONSIBILITIES INCLUDE:

• Effective, efficient use of agency resources, systems, equipment and processes.
• Continuous focus on cost savings initiatives across the responsibilities and deliverables.
• Effective use of time management to avoid overtime and budgetary issues.