Trilogy Behavioral Health

  • Authorization and Utilization Review Specialist

    Req No.
    2018-2078
    Type
    Regular Full-Time
    Department
    Billing
  • Overview

    About Trilogy Behavioral Healthcare:

                                                       
    Trilogy Behavioral Healthcare Inc. strongly believes that treatment services are more effective when provided in the client’s natural setting, hence, the majority of services provided are located in the community.  Trilogy Behavioral Healthcare Inc. also employs a holistic approach to each client’s treatment and integrates all facets of our clients’ lives including mental/emotional health, physical health/wellness, employment and education, social and family relationships, substance use/abuse issues, and housing needs.

     

    Typical services provided include case management, counseling/therapy, individual skills training, medication training, crisis intervention, linkage to community resources, advocacy, assessment, and treatment planning.

    Responsibilities

    The Authorization and Utilization Review Specialist is responsible for providing support to the billing department to obtain the initial and re-authorization for client services and maximize Medicaid and MCO claim revenues.

     

    Essential Responsibilities

    • Coordinate and educate clinical staff regarding the services to be provided & the necessary steps to successfully obtain authorizations
    • Primary liaison with state and MCO’s regarding authorizations and UR issues
    • Spearheads the Utilization Review processes at Trilogy; develops policies and procedures regarding Utilization Review; trains staff on Utilization Review processes
    • Communicate with administrative staff, clinicians, and Clinical Managers/Directors any pertinent information about the clients and their authorizations.
    • Interact with clinical sources to ensure timely and effective authorizations are obtained
    • Interact with clinical sources to track, record and review authorization statuses daily
    • Responsible for the initial authorization and re-authorization request for all clients
    • Submit authorization request forms to the clinical staff and obtain updates regarding member authorization for service
    • Submit authorization request forms to the insurance payers and manage the communication for authorization approval.
    • Communicate trends and issues regarding obtaining authorizations to Senior staff and or managers
    • When notified that a patient’s insurance has lapsed, communicates this to clinical staff and follows up with new insurance and obtains new authorization information.
    • Conducts Utilization Review reviews of client charts; reports deficiencies to clinical managers/directors
    • Perform other related duties and/or projects as assigned

    Qualifications

    • MA degree required
    • Licensed Clinical Social Worker, Licensed Clinical Professional Counselor, Licensed Practitioner of the Healing Arts, or Licensed Registered Nurse required
    • Minimum of 2 years experience in healthcare industry (particularly Medicaid and Managed Medicaid insurance companies)
    • In depth understanding of Authorization processes with all Medicaid payers
    • Strong Microsoft office skills (Word, Excel, Access, etc)
    • Experience with CareLogic preferred.
    • Highly detail oriented, with strong organizational skills
    • Strong financial analysis skills, analytical mindset, intellectual curiosity
    • Ability to investigate problems and develop/communicate solutions
    • Ability to meet assigned deadlines
    • Excellent communication and interpersonal skills with a focus on customer service
    • Ability to act and operate independently, with minimal supervision

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