Mindlance
BusinessOperations - Authorization Specialist II Authorization Sp...
Mindlance - Wilmington, North Carolina, United States, 28412
Work at Mindlance
Overview
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Overview
Job Description: Position Purpose:
Acts 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: candidate must reside in NC
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Centene Job Description 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 Story Behind the Need - Business Group & Key Projects Health plan or business unit Team culture Surrounding team & key projects Purpose of this team Reason for the request Motivators for this need ny additional upcoming hiring needs? Carolina Complete Health 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 N/ Position Purpose: Acts 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. Backfilling temp, Nia McCullers, who resigned position Hoping to find someone to convert N/ Typical Day in the Role
Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description 8a-5p, weekends included 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 Group Teams chat and follow up emails for record-keeping; team huddles weekly (Tuesdays); Monthly 1:1's; depending on skills/needs may possibly have 1:1's to help meet goals Professional, hardworking, open-door to ensure meeting goals Compelling Story & Candidate Value Proposition
What makes this role interesting? Points about team culture Competitive market comparison Unique selling points Value added or experience gained Has full support of Supervisor; open-door policy to help with moving forward in career; Supervisors are the gatekeepers to the authorizations (encourage staff of why they do/what they do in their everyday process regarding healthcare- "it is not a skill; it's a will"); being understanding as a leader; always leading/driving the team as we always set the expectation Group Teams chat and follow up emails for record-keeping; team huddles weekly (Tuesdays); Monthly 1:1's; depending on skills/needs may possibly have 1:1's to help meet goals N/ Not only gain the knowledge/experience, but the passion for the job and respect (main part of the job, keeping members with services and team paid); becoming a great communicator and becoming more adaptable to change successfully; being an open ear by hearing/receptive to the message Candidate Requirements
Education/Certification
Requires a High School diploma or GED Requires 1 - 2 years of related experience. Preferred: N/
Licensure
Required: N/ Preferred: N/
Years of experience required Disqualifiers Best vs. average Performance indicators Must haves: 1 - 2 years of related experience; Customer Service (working with internal/external members); MUST be tech savvy to be able to navigate through the systems; MUST have reliable internet service; MUST be able to hit the ground running and be committed to the schedule
Nice to haves: Some form of Medical terminology, but willing to be taught; great attendance record; remote-working experience; great organization; great flexibility/adaptability to change (open to change)
Disqualifiers: Gaps in experience on resumes, MUST be able to pass BGC should they be converted, how the interview processes may go can determine the disqualifiers, as well. Treat these on camera interviews as professional as you would if you were on an in-person interview.
(SIDE NOTE: HM works closely with the vendors when contractors are on assignment by having weekly calls to discuss performance updates)
Performance indicators: Non-phone role so MUST meet metrics of data entry and analytical skills; meet low error; utilizing system-based training materials
Best vs. average: (BEST) Show up and make your work speak for itself and being productive and vocal. Speak up and be heard without just letting any concerns fester and not try to resolve quickly to get your job done successfully. Look at your position as an opportunity to get closer to being converted.
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: candidate must reside in NC
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Centene Job Description 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 Story Behind the Need - Business Group & Key Projects Health plan or business unit Team culture Surrounding team & key projects Purpose of this team Reason for the request Motivators for this need ny additional upcoming hiring needs? Carolina Complete Health 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 N/ Position Purpose: Acts 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. Backfilling temp, Nia McCullers, who resigned position Hoping to find someone to convert N/ Typical Day in the Role
Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description 8a-5p, weekends included 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 Group Teams chat and follow up emails for record-keeping; team huddles weekly (Tuesdays); Monthly 1:1's; depending on skills/needs may possibly have 1:1's to help meet goals Professional, hardworking, open-door to ensure meeting goals Compelling Story & Candidate Value Proposition
What makes this role interesting? Points about team culture Competitive market comparison Unique selling points Value added or experience gained Has full support of Supervisor; open-door policy to help with moving forward in career; Supervisors are the gatekeepers to the authorizations (encourage staff of why they do/what they do in their everyday process regarding healthcare- "it is not a skill; it's a will"); being understanding as a leader; always leading/driving the team as we always set the expectation Group Teams chat and follow up emails for record-keeping; team huddles weekly (Tuesdays); Monthly 1:1's; depending on skills/needs may possibly have 1:1's to help meet goals N/ Not only gain the knowledge/experience, but the passion for the job and respect (main part of the job, keeping members with services and team paid); becoming a great communicator and becoming more adaptable to change successfully; being an open ear by hearing/receptive to the message Candidate Requirements
Education/Certification
Requires a High School diploma or GED Requires 1 - 2 years of related experience. Preferred: N/
Licensure
Required: N/ Preferred: N/
Years of experience required Disqualifiers Best vs. average Performance indicators Must haves: 1 - 2 years of related experience; Customer Service (working with internal/external members); MUST be tech savvy to be able to navigate through the systems; MUST have reliable internet service; MUST be able to hit the ground running and be committed to the schedule
Nice to haves: Some form of Medical terminology, but willing to be taught; great attendance record; remote-working experience; great organization; great flexibility/adaptability to change (open to change)
Disqualifiers: Gaps in experience on resumes, MUST be able to pass BGC should they be converted, how the interview processes may go can determine the disqualifiers, as well. Treat these on camera interviews as professional as you would if you were on an in-person interview.
(SIDE NOTE: HM works closely with the vendors when contractors are on assignment by having weekly calls to discuss performance updates)
Performance indicators: Non-phone role so MUST meet metrics of data entry and analytical skills; meet low error; utilizing system-based training materials
Best vs. average: (BEST) Show up and make your work speak for itself and being productive and vocal. Speak up and be heard without just letting any concerns fester and not try to resolve quickly to get your job done successfully. Look at your position as an opportunity to get closer to being converted.