Utilization Assistant

Description

This is a Part-time role. The ideal candidate must be detail oriented, organized, and have knowledge of Authorization Submission with Medicaid and Care Management Organizations (CMOs). Must be proficient with clinical documentation and have detailed writing skills. This job will share responsibilities within the Utilization Management department and coordinate with other staff. Must be able to work independently yet be a member of a team. Communication is key since hand offs may occur between weekday and weekend work coverage.

Responsibilities

The primary duties include but are not limited to the following:

• Insurance verification & insurance benefits

• Understanding of insurance, authorizations process and required clinical documentation

• Navigate GAMMIS platform and complete insurance verification and activity status

• Complete MyEvolv data entry regarding change in authorization status

• Follow-up with clinical requests for documentation with Chris Counseling Staff to submit authorization requests.

• Submit out-patient treatment requests to specific insurance companies through GAMMIS, Provider Connect, and CMO websites

• Interface with insurance companies regarding denials, pending authorizations, partial approvals.

• Provide updates to staff related to authorization status and follow-up with staff to obtain needed documentation from staff to submit authorizations in a timely manner

• Utilize the various sections within the electronic health record system, i.e., the message board to add information about authorization status and need clinical documentation

• Scan and upload documentation for individuals into their electronic health records related to authorizations

• Keep a weekly tracking system for authorizations and documentation due and update utilization department on status

• Provide weekly summaries to RCM regarding outstanding OTR’s, determination and unresolved workflow bottlenecks

• Understanding of Medicare/ Medicaid rules, DBHDD guidelines and CMO guidelines and be a resource to staff as related to authorizations requirements

• Be able to participate in other tasks related to the Utilization department that involves client charts.

Performance and Conduct

o Maintain confidentiality of consumer information

o Maintain appropriate professional boundaries

o Follow the CHRIS 180 Code of Ethics

o Follow mandated reporting requirements of the GA Code

o Support and maintain an environment of emotional and physical safety for consumers, staff and other stakeholders at all times.

Maintain Personal Information and Training

o Attend and participate in staff meetings as scheduled

o Attend and participate in required trainings as scheduled

o Maintain any required certifications

o Review, understand and responsible to program policies

o Provide documents in a timely fashion to Human Resources

o Report changes in status to HR as required by policy

Requirements

•Preferred Qualifications include BA Degree and 2 years’ experience within the clinical, educational and/or hospital setting connected to an understanding of the documentation necessary for authorizations and billing.

•Familiarity with searching payer web portals.

•Working knowledge of insurance companies and authorization.

•Great attention to detail, accuracy in documentation, organizational skills and the ability to perform multiple tasks successfully is essential.

•Ability to learn and understand new programs quickly.

•Ability to work independently as well as part of a team.

•Have solid decision-making ability with prioritizing authorizations that need to be submitted and manage other tasks related to the Utilization department.

•Be guided by precedent and established policy and procedure in decision-making. This person will be required to analyze and react to multiple situations.

•Dependability, emotional stability and physically capable.

•Ability to recognize when assistance and consultation is needed.

•Strong communication and interactive skills.

•Self-motivated and able to work under demand and deadlines

•Computer skills: Proficient in Microsoft Office (Word, Excel, Outlook)

Schedule

This is a Remote, Part-Time role falling between 10-15 hours per week, with the requirement of some onsite work during the first 30 days for training and onboarding. Saturday and Sunday hours between 9:00am – 5:00pm (may occasionally require Monday- Friday remote correspondence with seasonal flexibility). Being adaptable and reliable during non-traditional work hours is highly valued. Communication is key since handoffs may occur between weekday and weekend staff.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to sit, stand, and reach with hands and arms. The employee is occasionally required to lift and/or move up to 20 pounds.