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Clinical Authorization Specialist

Thresholds

Job description

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)

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