Mindlance
BusinessOperations - Authorization Specialist II Authorization Specialist II
Mindlance, Texas City, Texas, us, 77592
Job Description: Position Purpose:
cts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
Education/Experience: Requires a High School diploma or GED Requires 1 - 2 years of related experience.
Knowledge of medical terminology and insurance preferred.Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment
Performs data entry to maintain and update various authorization requests into utilization management system
Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer
Remains up-to-date on healthcare, authorization processes, policies and procedures Performs other duties as assigned
Complies with all policies and standards Comments for Vendors: Must type more than 40WPM, Proficient in basic computer knowledge, MS word, excel, outlook, etc. Some medical background. Must be willing to work on weekends. Hours will be 10a-7p Tuesday - Friday and 8a-5p Saturday.
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD): Summary:
ssist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Job Responsibilities
: Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed. Verify eligibility and benefits Process faxes within established standards, follow up outbound calls (can answer phone queue occasionally) Data enters authorizations into the system Describe the performance expectations/metrics for this individual and their team:
Create 35 to 40 faxes minimum per day dherence to schedule and breaks ttendance Quality audits (error rates - must stay under 1%) Tell me about what their first day looks like:
Day 1: Introductions, will learn prior authorizations, training curriculum Training is around 2 weeks, may go longer depending on the individual and how quickly they catch on - flexible to ensure each individual is set up for success What previous job titles or background work well in this role?
Customer Service background bility to type quickly Coming from a data/production-driven environment is helpful What makes your team/department/culture special that you would like candidates to know?
We are very connected as a team. We value each other opinions and feedback. Multiple cross trainings. We train our staff on other pods so we can support them as well.
Education/Experience: Requires a High School diploma or GED Requires 1 - 2 years of related experience.
Knowledge of medical terminology and insurance preferred.Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment
Performs data entry to maintain and update various authorization requests into utilization management system
Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer
Remains up-to-date on healthcare, authorization processes, policies and procedures Performs other duties as assigned
Complies with all policies and standards Comments for Vendors: Must type more than 40WPM, Proficient in basic computer knowledge, MS word, excel, outlook, etc. Some medical background. Must be willing to work on weekends. Hours will be 10a-7p Tuesday - Friday and 8a-5p Saturday.
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD): Summary:
ssist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Job Responsibilities
: Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed. Verify eligibility and benefits Process faxes within established standards, follow up outbound calls (can answer phone queue occasionally) Data enters authorizations into the system Describe the performance expectations/metrics for this individual and their team:
Create 35 to 40 faxes minimum per day dherence to schedule and breaks ttendance Quality audits (error rates - must stay under 1%) Tell me about what their first day looks like:
Day 1: Introductions, will learn prior authorizations, training curriculum Training is around 2 weeks, may go longer depending on the individual and how quickly they catch on - flexible to ensure each individual is set up for success What previous job titles or background work well in this role?
Customer Service background bility to type quickly Coming from a data/production-driven environment is helpful What makes your team/department/culture special that you would like candidates to know?
We are very connected as a team. We value each other opinions and feedback. Multiple cross trainings. We train our staff on other pods so we can support them as well.