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Job

Authorization Specialist

Thresholds

Job description

The Authorization Specialist is responsible for successfully securing required service authorizations for new and existing members, as required by all assigned payers. Ensures required clinical documentation is complete and provided to the payer in a timely manner.

ESSENTIAL DUTIES & RESPONSIBILITIES

  • Works as part of a team with other Authorization and Quality Staff.
  • Effectively communicates with all payer organizations to secure authorizations for services related to the treatment plan for members.
  • Documents the authorization number for units approved under approvals for services.
  • Proactively monitors all aspects of the authorization process for new registrations as well as concurrent services, including Level of Care changes.
  • Maintains accurate and current shared logs of members and authorization status for each program. Communicates with program staff regarding missing documentation required by the payer.
  • Keeps the team leader aware of any problems which might impact the success of securing required authorizations, (e.g., treatment plan changes, program changes, site changes, etc.).
  • Facilitates communication between payers and Thresholds’ programs to ensure programs are successfully meeting compliance requirements associated with government programs and/or commercial payers.
  • Remains informed of trends and regulations to ensure agency effectiveness and compliance.
  • Designs and generates reports as needed.
  • Actively promotes and personally observes safety and security procedures, using equipment and materials properly.
  • Assists with appeals where authorizations have been denied by payers
  • Will work Remote
  • May be required to work a flexible schedule
  • Hours: 8am to 4:30pm  Mon-Fri

REQUIREMENTS

  • Bachelor’s degree from an accredited college or university.
  • Knowledge of Medicaid/Medicare/Commercial Payers strongly preferred
  • Strong knowledge of Rule 132 Medicaid community mental health service program requirements
  • Ability to read and understand clinical notes
  • Proficient in Microsoft Office with strong Excel skills
  • Covid-19 Note
    • In the spirit of caring for one another and our community, please note that upon accepting an offer of employment from Thresholds, you will be required to share proof of a COVID-19 vaccination and booster upon eligibility.  You may apply for a Medical or Religious Exemption in compliance with applicable laws and regulations.

WHAT WE OFFER

  • Generous Paid Time Off Policy (Vacation, Sick, and Personal Days)
  • 4 Medical Insurance Plans
  • Dental Insurance
  • Vision Insurance
  • 403(b) with 3% employer match
  • Mileage Reimbursement
  • Public Service Loan Forgiveness

 

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