Pre-authorization Assistant - Washington, United States - The HSC Health Care System

The HSC Health Care System
The HSC Health Care System
Verified Company
Washington, United States

2 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

Pre-Authorization Assistant
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(
)

Description
Works under the direction of the Director of Utilization Management and UM Review staff.

Provides support to UM Reviewers by:

managing the UM Department's main phone line and transfers calls to appropriate staff as indicated, opening UM cases by creating authorization shells in the HSCSN electronic Record, sending requests for review to the appropriate UM reviewer based on service being requested and attaching documents related to UM activities to the HSCSN electronic record.


Qualifications

Minimum Education
High School Diploma or GED (required)


Minimum Work Experience
2 years related experience in managed care. (preferred)


Required Skills/Knowledge
Knowledge of medical terminology.
Demonstrated skills and ability to work collaboratively in a team environment.
Strong written and oral communication skills.
Strong organizational skills.
Computer literate in Microsoft suite.


Required Licenses and Certifications
Driver's License (preferred)


Job Functions

Essential job duties:


  • Obtains clinical information required for review and documentation of precertification requests and routes to the appropriate individuals for processing.
  • Monitors fax machines, faxes queues, and mail for authorization/reauthorization requests and routes information timely to the appropriate individuals for processes.
  • Receives calls from enrollees and providers, assesses nature of call and completes requests.
  • Answers inquiries from enrollees/caregivers and providers, and routes to appropriate review nurse or Chief Medical Officer.
  • Assist clinical staff identifying and securing vendors for services requiring prior authorization (home health, supplies, durable medical equipment, etc.).
  • Enters authorizations and/or provides service authorizations to vendors as requested by clinical staff.
  • Communicate authorization information to vendors timely and accurately.
  • Documents all relevant information and communication, links documents or other information in the HSCSN IT system.
  • Seeks advice from UM Director or other designated person(s) with expertise in specialty areas when necessary.
  • Effectively resolves inquires related to status of authorization requests.
  • Provides accurate and timely documentation to care management staff in the IT system.
  • Identifies and seeks guidance for potential risks and utilization concerns.
  • Demonstrates compliance with authorization timeliness and case closure.
  • Documents according to policy as it related to authorization process.
  • Researches and answers provider and vendor authorization inquiries.
  • Demonstrates compliance with work flow and department processes.
  • Demonstrates customer service, and phone etiquette.
  • Demonstrates time and attendance.

Other job duties:


  • May perform other duties in addition to those outlined in this job description.

Organizational Accountabilities
Organizational Accountabilities (Staff)
Employee Excellence
All In
Action Oriented Supervisory Responsibilities

  • None
Blood Borne Pathogen Exposure

  • Category II: Job may expose incumbent occasionally or in emergency situations to blood, body fluids, nonintact skin or tissue specimens.
Protected Health Information Access Level

  • Level IV
  • Full Access Incumbents in this job may access any protected health information associated to a customer's needs, the service(s) rendered and the position's functions.
Working Environment

  • This job operates in an office environment.
Physical Requirements

  • Sedentary Work: Lifting 10 lbs. maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.
Travel Requirements

  • Frequent travel requirements for this position. The incumbent should have a valid driver's license and access to a motor vehicle.

Primary Location:
District of Columbia-Washington


Work Locations:
HSCSN Vermont 1101 Vermont Ave NW Washington 20005


Job:
Administrative Support / Customer Service


Organization:
HSC W/Special Needs


Position Status:
R (Regular) - FT - Full-Time


Shift:
Day


Work Schedule:
Monday -Friday


Job Posting:
Apr 19, 2024, 8:03:30 AM
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