What are the responsibilities and job description for the Authorization Specialist position at McGregor PACE?
Job Description
Job Description
McGregor PACE (Program of All-inclusive Care for the Elderly) is a community-based service program that provides in-home healthcare services to the elderly as an alternative to nursing home placement, allowing Seniors to remain at home.
We are seeking a highly motivated and dedicated Authorization Specialist to join our team at PACE. As an Authorization Specialist , you will be responsible for providing open communication with administrative staff, hospitals, and medical outpatient offices regarding the status of authorization requests, and related topics.
Responsibilities :
- Send authorizations in a timely manner to prevent billing delays and / or denial of payments.
- Prepare and complete prior authorization request forms and apply appropriate guidelines to prior authorization requests. Including inpatient, respite, ICF, skilled, and LTC within 24 to 48 hours.
- Prepare and complete authorization request forms for weekend admissions within 72 hours to ensure timely integration of data into Intus Care.
- Prepare and complete authorizations for outpatient visits daily within the guidelines.
- Determine when the request does not meet PACE guidelines and coordinate appropriate follow-up by clinical staff members that aid in the prior authorization process.
- Respond to the designated authorization email address promptly for inquiries from providers as needed.
- Respond to inbound calls as needed.
- Responsible for' entering discharge dates into Truchart as the participant's status changes. Including hospitals, respite, and skilled, ICF, and LTC. Delete alerts if they are no longer valid.
- Update the PCP inpatient report with the authorization expiration dates as needed.
- Notify PACE providers by email of request for authorization if no order is listed in Truehart, follow up within 2 business days for their response.
Minimum Qualifications :
Preferred Qualifications :
