DeKalb Community Service
Claratel Behavioral Health is an innovative, community-based behavioral health and developmental disabilities services organization located in metropolitan Atlanta, Georgia, offering a full range of mental health services, developmental disabilities programs and substance abuse treatment to more than 11,000 citizens annually who are uninsured and underinsured. As a public, not-for-profit organization, Claratel Behavioral Health operates more than 20 locations in DeKalb County with a diverse workforce of more than 500 direct-care and support staff. Our staff of physicians, nurses, clinicians and support personnel is dedicated to helping our clients and their families recover from these debilitating disabilities and resume productive lives. We strive to provide the highest quality, evidence-based services in the least restrictive settings, and we envision a community in which disabilities no longer limit potential.
AUTHORIZATION SPECIALIST WINN WAY - CARE MANAGEMENT 307
The Authorization Specialist will be responsible for the daily processing of all authorization files/requests daily. Works closely with each clinician on any requests that are on review. Ensures all behavioral health programs are obtaining and submitting authorizations in a timely fashion. Assists clinicians with questions or concerns they may have regarding authorizations. Oversees and works on all authorization related issues. Conducts training on CMO authorizations, ASO related issues, coding/billing updates and eligibility issues. Creates reports for managerial staff to summarize errors.
DUTIES & RESPONSIBILITIES:
Under general supervision, incumbent duties and responsibilities will include but is not limited to the following: • Coordinate/manage all ASO and Care Management Organization (CMO) authorization requests for DeKalb CSB • Oversees the authorization process end to end making changes as identified and resolving of billing discrepancies • Electronically submits, receives, and process data on a daily basic. Analyzes reports and correct errors and/or inform appropriate staff of error to be corrected and re-submit • Review documentation and coordinate with clinical team members to ensure the State and CMO clinical requirements/standards are being met • Coordinate with the UM Manager regarding any authorization reviews and appeals • Use advanced tools to analyze data and conduct comprehensive clerical research using a variety of resources to generate reports and responds to requests • Enter data from forms, records, and/or reports using a computer or terminal. Code information as appropriate
SKILL, COMPETENCY AND EDUCATION AND/OR LICENSURE REQUIREMENTS: • Demonstrate overall knowledge of authorization and claims processing for insurance companies and plans both private and government. • Demonstrate the ability to make decisions, assess, and resolve problems effectively. • Demonstrates the ability to maintain the confidentially of all records • Demonstrated ability to manage multiple tasks and demands given tight times constraints while ensuring a high degree of accuracy and attention to detail. • Effective interpersonal skills in a diverse population • Ability to interpret and apply agency policies and procedures • Ability to communicate effectively, both orally and written • Ability to establish and maintain effective working relationships with others • Completion of an Associate degree from an accredited college or two years of related experience • Experience with SFTP protocols • Microsoft Excel- creating spreadsheets, filtering, and pivot tables • Microsoft Word- creating error templates and documentation
Pre-employment drug screening may be required. Selected applicant will be subject of an FBI Criminal History Record Check, and the applicant has the right to challenge the contents of their Criminal History Record Information, should they choose to do so. This employer participates in E-Verify.
For more information visit www.dekcsb.org/careers
DeKalb CSB is an equal opportunity employer regarding disability under VEVRRA and ADA
Thank you so much for your interest in joining our team! Due to the high number of applications we receive, we'll be reaching out directly to those selected for an interview. We truly appreciate your understanding and wish you the very best in your job search journey.
Claratel is an Equal Employment Opportunity Employer (EOE).
It has been and will continue to be a fundamental policy of Claratel not to discriminate on the basis of race, color, creed, religion, gender, gender identity, pregnancy, marital or partnership status, domestic violence victim status, sexual orientation, age, national origin, alienage or citizenship status, veteran or military status, disability, medical condition, genetic information, caregiver status, unemployment status or any other characteristic prohibited by federal, state and/or local laws. This policy applies to all aspects of employment, including hiring, promotion, demotion, compensation, training, working conditions, transfer, job assignments, benefits, layoff and termination
Claratel Behavioral Health participates in E-Verify (Company ID: 226305)
AUTHORIZATION SPECIALIST WINN WAY - CARE MANAGEMENT 307
The Authorization Specialist will be responsible for the daily processing of all authorization files/requests daily. Works closely with each clinician on any requests that are on review. Ensures all behavioral health programs are obtaining and submitting authorizations in a timely fashion. Assists clinicians with questions or concerns they may have regarding authorizations. Oversees and works on all authorization related issues. Conducts training on CMO authorizations, ASO related issues, coding/billing updates and eligibility issues. Creates reports for managerial staff to summarize errors.
DUTIES & RESPONSIBILITIES:
Under general supervision, incumbent duties and responsibilities will include but is not limited to the following: • Coordinate/manage all ASO and Care Management Organization (CMO) authorization requests for DeKalb CSB • Oversees the authorization process end to end making changes as identified and resolving of billing discrepancies • Electronically submits, receives, and process data on a daily basic. Analyzes reports and correct errors and/or inform appropriate staff of error to be corrected and re-submit • Review documentation and coordinate with clinical team members to ensure the State and CMO clinical requirements/standards are being met • Coordinate with the UM Manager regarding any authorization reviews and appeals • Use advanced tools to analyze data and conduct comprehensive clerical research using a variety of resources to generate reports and responds to requests • Enter data from forms, records, and/or reports using a computer or terminal. Code information as appropriate
SKILL, COMPETENCY AND EDUCATION AND/OR LICENSURE REQUIREMENTS: • Demonstrate overall knowledge of authorization and claims processing for insurance companies and plans both private and government. • Demonstrate the ability to make decisions, assess, and resolve problems effectively. • Demonstrates the ability to maintain the confidentially of all records • Demonstrated ability to manage multiple tasks and demands given tight times constraints while ensuring a high degree of accuracy and attention to detail. • Effective interpersonal skills in a diverse population • Ability to interpret and apply agency policies and procedures • Ability to communicate effectively, both orally and written • Ability to establish and maintain effective working relationships with others • Completion of an Associate degree from an accredited college or two years of related experience • Experience with SFTP protocols • Microsoft Excel- creating spreadsheets, filtering, and pivot tables • Microsoft Word- creating error templates and documentation
Pre-employment drug screening may be required. Selected applicant will be subject of an FBI Criminal History Record Check, and the applicant has the right to challenge the contents of their Criminal History Record Information, should they choose to do so. This employer participates in E-Verify.
For more information visit www.dekcsb.org/careers
DeKalb CSB is an equal opportunity employer regarding disability under VEVRRA and ADA
Thank you so much for your interest in joining our team! Due to the high number of applications we receive, we'll be reaching out directly to those selected for an interview. We truly appreciate your understanding and wish you the very best in your job search journey.
Claratel is an Equal Employment Opportunity Employer (EOE).
It has been and will continue to be a fundamental policy of Claratel not to discriminate on the basis of race, color, creed, religion, gender, gender identity, pregnancy, marital or partnership status, domestic violence victim status, sexual orientation, age, national origin, alienage or citizenship status, veteran or military status, disability, medical condition, genetic information, caregiver status, unemployment status or any other characteristic prohibited by federal, state and/or local laws. This policy applies to all aspects of employment, including hiring, promotion, demotion, compensation, training, working conditions, transfer, job assignments, benefits, layoff and termination
Claratel Behavioral Health participates in E-Verify (Company ID: 226305)