BusinessOperations - Authorization Specialist I - Authorization Specialist I

Job Description: Position Purpose:
Supports the prior authorization request to ensure all authorization requests are addressed properly and in the contractual timeline. Aids utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
Education/Experience:
Requires a High School diploma or GED
Entry-level position typically requiring little or no previous experience.
Understanding of medical terminology and insurance preferred.
Supports authorization requests for services in accordance with the insurance prior authorization list
Responsibilities: Supports and performs data entry to maintain and update authorization requests into utilization management system
Assists utilization management team with ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
Contributes to the authorization review process by documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
Remains up-to-date on healthcare, authorization processes, policies and procedures
Performs other duties as assigned
Complies with all policies and standards
Comments for Vendors: Looking for experience in intake and authorization, some Medi-cal knowledge would be helpful for this role as well as Client medical experience. Job is business hours therefore candidate would be expected to be available during office hours. Long Term Custodial experience preferred
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Centene Job Description Supports the prior authorization request to ensure all authorization requests are addressed properly and in the contractual timeline. Aids utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
Education/Experience:
Requires a High School diploma or GED
Entry-level position typically requiring little or no previous experience.
Understanding of medical terminology and insurance preferred.
Supports authorization requests for services in accordance with the insurance prior authorization list
Responsibilities: Supports and performs data entry to maintain and update authorization requests into utilization management system
ssists utilization management team with ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
Contributes to the authorization review process by documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
Remains up-to-date on healthcare, authorization processes, policies and procedures
Performs other duties as assigned
Complies with all policies and standards
Story Behind the Need - Business Group & Key Projects

• Health plan or business unit
• Team culture
• Surrounding team & key projects
• Purpose of this team
• Reason for the request
• Motivators for this need
• ny additional upcoming hiring needs?

This request is to replace temp Jade Halloway-Gipson. Need additional temp to manage workload.
May support in community support. Typical Day in the Role

• Daily schedule & OT expectations
• Typical task breakdown and rhythm
• Interaction level with team
• Work environment description

Will need to review documents received via fax and extract information needed to build authorization. Occasionally doing out reach to provider to obtain clarification of request or missing information. Required to send out notification of determination and adhere to strict deadlines. Will need ability to have good communication skill both verbal an written as letter will need to be created for providers per Medical guidelines. Compelling Story & Candidate Value Proposition

• What makes this role interesting?
• Points about team culture
• Competitive market comparison
• Unique selling points
• Value added or experience gained

Candidate Requirements Education/Certification Required: High School diploma. Preferred: Licensure Required: Preferred:

• Years of experience required
• Disqualifiers
• Best vs. average
• Performance indicators

Must haves: Medical background, authorization experience
Nice to haves: Medicaid experience, excel background
Disqualifiers: Location, must be CA.
Performance indicators: Maintain quality of 95% or better. Maintain production of 95% or better.
Best vs. average:

• Top 3 must-have hard skills
• Level of experience with each
• Stack-ranked by importance
• Candidate Review & Selection

1 Microsoft 2 3 Candidate Review & Selection

• Shortlisting process
• Second touchpoint for feedback
• Interview Information
• Onboard Process and Expectations

Projected HM Candidate Review Date: SAP Number and Type of Interviews: 1 Extra Interview Prep for Candidate: No Required Testing or Assessment (by Vendor): No Manager Communication Preferences & Next Steps

• Background Check Requirements (List DFPS or other specialty checks here)

No

• Do you have any upcoming PTO?

6/6-

• Colleagues to cc/delegate

Sonia Cloud