Provider Services Specialist

Job Description

Job Description

POSITION SUMMARY :

Responsible for assisting management with denial recoupment and appeals. Maintains accurate documentation to reflect all contacts made. Responsible for completing prior authorizations for outpatient services based on fund source requirements and entry of authorizations into Avatar in a timely fashion. Responsible for continued coverage verification. Maintain agency provides roster management for contracted managed care companies. Reports to and functions under the direction, instruction, and supervision of the Provider Services Supervisor.

QUALIFICATIONS :

Bachelor’s degree from an accredited college or university or AA, plus one year of experience in a related field. Need to be able to read and write proficiently, needs to be able to utilize Microsoft Word, Excel, Outlook, PowerPoint & Avatar.

PHYSICAL DEMANDS :

Abilities in reaching, bending, talking, sitting, carrying, standing, grasping, fine hand coordination, the ability to read and write, and the ability to remain calm under stress. Ability to reach with hands and arms, climb stairs, balance, stoop, kneel, crouch, or crawl. Must be capable of lifting 20 pounds alone.

WORK ENVIRONMENT :

General office, health care setting. Most work is completed while sitting at the desk using standard office equipment. Fast-paced team approach. Multi-tasking ability requires above-average time management skills.

FUNCTIONAL RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO :

• Assist with agency provider roster management for contracted managed care companies as needed.
• Assist in completing prior authorizations for outpatient services based on fund source requirements. Including completing continued authorization related to OP services and entry of authorizations into Avatar
• Assists in the appeals and retro process for denied authorization and claims.
• Tracks authorizations and conducts reviews of patient care with consumers’ insurance companies & / or DCF / CFBHN, as indicated by job assignments, before or on the next due date.
• Compiles necessary and requested data to the manager, supervisor, and other departments as assigned or requested
• Provides discharge information to close out the case and finalize the authorization.
• Timely and accurate entry of all contacts with managed care companies into the UM tracking form on Avatar (inpatient) or tracking log (outpatient).
• Verifies funding at the beginning of each month for all consumers on the case load. Enter / update the financial eligibility screen as needed.
• Maintains good communication with other managed care staff, as well as programs providing service(s), regarding funding & authorization issues.

Mon-Fri 8 : 00am-4 : 30pm