Trilogy Behavioral Health

  • Authorization and Utilization Review Specialist

    Req No.
    2018-2193
    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

    Job Summary

    The Authorization and Utilization Review Specialist is responsible for providing support to the Billing Department to obtain initial and re-authorizations for client services, and maximize Medicaid and Managed Care Organization (MCO) claim revenues. 

     

    Essential Responsibilities

    • Primary liaison with the state and MCO’s regarding authorizations and utilization review issues for the agency.
    • Coordinate and educate employees regarding services provided, and the necessary steps to successfully obtain authorizations. Partner with clinicians to ensure documentation is timely and supports the services identified. 
    • Spearhead the utilization review process. Develop policies, procedures, and guidelines; and train employees on the process. 
    • Submit and obtain updates regarding authorizations for service. Communicate with employee’s pertinent information about the clients or their authorizations
    • Review authorizations reports; and identify trends, issues, or barriers regarding obtaining authorizations to leadership
    • Conduct utilization reviews of client charts. Report deficiencies to leadership. 
    • Communicate to employees when a client’s insurance has lapsed. Collaborate with new insurance to obtain authorization information. 
    • Perform other related duties and/or projects as assigned

    Qualifications

    • Master’s degree in Psychology, Social Worker, Counseling, Behavioral Health, or other closely related field highly preferred
    • Licensed Clinical Social Worker, Licensed Clinical Professional Counselor, or Licensed Registered Nurse required
    • Minimum 2 years of experience in the healthcare industry (particularly Medicaid and Managed Medicaid insurance companies)
    • Thorough understanding of the authorization process with Medicaid payors
    • Experience with CareLogic system preferred.
    • Strong understanding of Microsoft applications; i.e. Excel, Outlook, Access, Word
    • Ability to investigate problems and develop/communicate solutions
    • Excellent oral, written, and interpersonal communication skills with a focus on customer service
    • Ability to meet deadlines; highly detailed oriented; strong financial analysis and organizational skills; and analytical mindset with intellectual curiosity
    • Ability to act and operate independently with minimal supervision

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