Authorization Research Specialist Iii
Current• Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. • Perform tasks necessary to promote compliance within corporate policy. • Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. • Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list and Medicaid guidelines. Route to appropriate staff when needed.• Research claims inquiry specific to the utilization management department for claims department and providers.• Reporting, including the Check Run and PENDS reports, and data collection for management.• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results, and medical records. Assess and monitor inpatient stays.• Work collaboratively with clinical team, providers, and vendors (home health agencies, equipment vendors) to ensure member’s receive appropriate care. • Entering data, assessments, and authorizations into various systems while ensuring appropriate record keeping, organization of training programs and implementation of any related processes.• Efficiently handling and processing high volumes of work and complex data sets, ensuring accuracy and timely completion.