What are the responsibilities and job description for the Authoriations Specialist position at Threshold Billing Solutions?
Description
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Behavioral Health Authorization/Utilization Specialist
Position Summary: Threshold Billing Solutions provides claims processing and utilization management services for behavioral treatment facilities. The UR Specialist is responsible for collecting clinical information and communicating with MCO’s in a timely manner in order to advocate for the highest level of care that is supported by the client’s acuity, and in compliance with procedures as defined by Threshold Billing Solutions. This position is responsible for communicating with insurance companies/payor sources as an advocate for the client’s served including the treatment facility staff assigned. Essential functions include those listed below:
Essential Job Functions:
- Establish and maintain positive and frequent effective communication with insurance carriers.
- Read and understand client’s clinical chart narrative and respective case notes and be able to disseminate client needs and professional/clinical recommendations and communicate this information effectively.
- Manage clinical documentation related to initial treatment admissions, concurrent reviews, appeals for the purpose of obtaining authorization of the client’s appropriate level of care.
- Obtain and communicate level of care and authorizations and properly enter information into Threshold’s data systems.
- Complete and submit quality authorization/review documentation verbally, and/or via fax/email.
- Serve as an advocate for clients in relation to their care and their insurance benefits.
- Responsible for tracking current & ongoing authorization needs for all levels of care.
- Responsible for detailed system documentation of authorizations in a timely and accurate manner.
- Communicating with other departments to obtain or provide needed information on client accounts.
- All other related duties as assigned.
Essential Qualifications:
- Knowledge of CPT, ICD 10 coding, ASAM/LOCUS, and EMR/CDS Systems is preferred but not required.
- Collaboration, negotiation, and assertiveness skills.
- Must be organized, detail oriented and have the ability to focus on several job-specific tasks with several potential surrounding distractions and patient traffic.
- Excellent verbal and written communication skills.
- Ability to perform complex tasks and to prioritize multiple projects.
- Strong analytical and critical thinking skills and the ability to analyze, summarize, and effectively present clinical data.
- Ability to work collaboratively with others in a manner that is pleasant and professional.
- Ability to exercise good judgment and discretion.
- Ability to operate a computer and complete documents in Microsoft and Google formats.
- Ability to complete work tasks within scheduled work hours.
- Excellent verbal and written communication skills.
- Requires the ability to work under stress and deadlines.
Other Job Details/Compensation
- Full-time (40 hours in a professional office setting.
- Location: Sandy, Utah
- Salary Range Depending on Experience: $35,360 - $50,000.
- Must be willing to start by working on-site in our office. Working remote for part of the week may be an option in the future depending on proficiency and needs,
Education/Experience:
- High school or equivalent, preference given to those with associate degree or higher.
- Utilization review: 1 year (preferred but not required).
- Behavioral Health Treatment: 1 year (preferred but not required) experience working in a behavioral health treatment setting.
Benefits:
- Health Insurance
- Dental Insurance
- Vision Insurance
- Paid Time-Off
- Long and Short-Term Disability Coverage
- Life Insurance
Salary : $35,360 - $50,000