Clinical Authorization Specialist

The Clinical Authorization Specialist, reporting to the Manager, Authorizations, will complete Medicaid authorization requests, Illinois Medicaid Comprehensive Assessment of Needs and Strengths (IM+CANS) reviews.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Complete and review Medicaid Authorization requests. Ensure compliance, accuracy, timeliness, and appropriate documentation.
• Review member IM+CANS, Psychiatric Evaluations, Co-occurring Assessments, Service Notes, and any additional documentation to effectively complete Authorization requests
• Coordinate with treatment teams to gather additional clinical information necessary to complete authorizations accurately and thoroughly
• Communicate with insurance companies for status or issues on requests submitted
• Complete appeals for denials in a timely manner
• Thoroughly review reports for expiration dates and remaining units to ensure authorizations are completed and submitted in a timely manner
• Advise direct service staff regarding appropriate procedures or practices in response to completion of Authorization and IM+CANS documentation
• Develops and deploys training materials to decrease # of errors and omissions in documentation that result in rejected billing
• Assist in IM+CANS review and signature process. Ensure compliance, accuracy, timeliness, and appropriate documentation
• Will work Remote
• Hours: 8am to 4:30pm Mon-Fri

EDUCATION

Must, at a minimum, meet Office of Mental Health Rule 132 credential requirements for a Mental Health Professional including a Bachelor’s in social work, counseling, psychology or closely related field.

EXPERIENCE

• Familiarity and working knowledge of Clinical Operations and Quality Operations.
• Non-Profit and/or health care experience preferred.
• Committed to achieving results under demanding time frames.

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. The requirement is subject to accommodation 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
• Supervision for Clinical Licensure at no cost (LSW, LCSW, LPC, LCPC)