Behavioral Health Services of Virginia
Authorization/Compliance Manager
Behavioral Health Services of Virginia, Henrico, Virginia, United States, 23228
Description
DUTIES AND RESPONSIBILITIES:
Manages the operation of departmentalAct as the public speaker and public relations representative of the company in ways that strengthen its profileEnsure adherence of the organization's daily activities and long-term plans to established policies and legal guidelinesManagement of our Risk ManagementAssess service capacity and staffing needs; ensures adequate staffing patterns.Approves all personnel decisions, including position appointments, terminations, and disciplinary actions.Oversite of all department complianceAnswer, screen, and transfer inbound calls from Managed Care Organizations (MCO)Communicates with Quality Assurance to obtain documents from filing system and file roomCommunicates authorization information to staff as updates are receivedCommunicates insurance discrepancies with staff as neededWork with staff to investigate and determine the authorization statusReview forms for accuracy and completeness before faxing to MCOIdentifies and documents trends/problems with approvals and denials with authorizationsModify and update tracking systems daily with the current statusEnters and transfers authorizations data in a timely and accurate manner into Electronic Health SystemAssist with the appeals process when necessaryAny other assigned duties or responsibilities
Requirements
MINIMUM QUALIFICATIONS:
A Bachelor's degree in Social Work, Psychology, Human Services, or a related field from an accredited college or university;
DUTIES AND RESPONSIBILITIES:
Manages the operation of departmentalAct as the public speaker and public relations representative of the company in ways that strengthen its profileEnsure adherence of the organization's daily activities and long-term plans to established policies and legal guidelinesManagement of our Risk ManagementAssess service capacity and staffing needs; ensures adequate staffing patterns.Approves all personnel decisions, including position appointments, terminations, and disciplinary actions.Oversite of all department complianceAnswer, screen, and transfer inbound calls from Managed Care Organizations (MCO)Communicates with Quality Assurance to obtain documents from filing system and file roomCommunicates authorization information to staff as updates are receivedCommunicates insurance discrepancies with staff as neededWork with staff to investigate and determine the authorization statusReview forms for accuracy and completeness before faxing to MCOIdentifies and documents trends/problems with approvals and denials with authorizationsModify and update tracking systems daily with the current statusEnters and transfers authorizations data in a timely and accurate manner into Electronic Health SystemAssist with the appeals process when necessaryAny other assigned duties or responsibilities
Requirements
MINIMUM QUALIFICATIONS:
A Bachelor's degree in Social Work, Psychology, Human Services, or a related field from an accredited college or university;