Authorization Specialist
DeKalb Community Service Board
- Decatur, GA
- Permanent
- Full-time
WINN WAY - CARE MANAGEMENT 307The Authorization Specialist will be responsible for the daily processing of all authorization files/requests daily. 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
- 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 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