SERV Behavioral Health System, Inc.

  • Authorization Specialist - Ewing, NJ

    Job Locations US-NJ-Mercer County
    Posted Date 3 months ago(2/2/2018 2:50 PM)
    ID
    2018-1277
    # of Openings
    1
    Category
    SERV Centers
    Country
    US
  • Overview

    SERV, a well-established leader in behavioral healthcare in NJ, provides a wide range of quality residential and support services.  We are in need of compassionate and caring individuals who would like to support our consumers in achieving greater independence and life satisfaction.

     

    We are in need of an Authorization Specialist that will be responsible for obtaining initial authorization for service and subsequent re-authorization for services for clients in SERV Achievement and SERV Centers with Medicaid, Medicaid Managed Care, Commercial payers, State/Agency Contracts, and Out of Network Agreements, who are receiving treatment and services in a variety of programs provided by SERV Behavioral Health System, Inc.

    Responsibilities

    • Obtaining clinical/programmatic documentation from the requesting treatment or service program to support the funder’s requirement for requesting initial authorization for service;
    • Completion of authorization request submissions via paper and/or on-line;
    • Tracking authorization requests and receipt of initial authorizations; following up in a timely manner on requests that have not resulted in initial authorizations from a funder;
    • Communication with program/service personnel regarding the status of the initial authorization for service and the start date of the client in the program;
    • Comparing the initial authorization received to the authorization requested; following up with the funder if the authorization received does not match the authorization requested and getting corrections to the funder’s authorization as needed;
    • Accurately entering the authorization information onto the agency’s EHR/Billing system.
    • Running and working reports to verify correct entry of authorization information
    • Running and working reports to determine when subsequent reauthorization packets are to be completed and submitted;
    • Running and working reports to identify if adjustments are required to units of service within authorizations to prevent units from being depleted before the end of the authorization period; submission of requests for additional units of service to funders as needed to assure authorization coverage for all services provided;
    • Submission of continuing care authorizations in a timely manner and in the format required by the funder;
    • Tracking requests submitted and subsequent authorizations received;
    • Comparing the subsequent authorization received to the authorization request; resolving any discrepancies with the funder;
    • Accurately entering subsequent authorization data onto the EHR/Billing system.
    • Accurately end-dating authorizations on the agency system when clients terminate treatment or authorizations are updated;
    • Accurately adding updated authorization data to the agency system to assure accurate billing of the service;
    • Researching claim denials related to authorization issues and resolving them so that the service can be rebilled correctly.
    • Tracking authorization issues by payer and by program/service in order to identify areas of process improvement and clarification;
    • Regularly reviewing funders’ policy and procedure manuals, bulletins, and alerts for changes to authorization policies and procedures and proactively responding to changes by alerting clinical personnel and shepherding changes through the system.
    • Works independently with funders and program personnel to assure adherence to all funders’ authorization requirements and to resolve problems as needed;
    • Maintains accurate and complete files and documentation.
    • Performs special projects in ATC as requested by manager.
    • With cross-training, provides coverage for other ATC personnel who are absent from work;
    • Cross trains other ATC personnel in authorization management processes so that coverage is always available for this position in ATC.

    Qualifications

    High School Diploma required. Associates or Bachelor’s Degree strongly preferred.    Familiarity with insurance required.  3-5 years of experience in Health Care and/ or with Insurance Authorizations strongly preferred. 

     

    Come Join Us Now!

    SERV is an Equal Opportunity Employer

    If you are interested in this position, please apply below.

    https://careers-servbhs.icims.com/

    *CB

     

     

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