ADS Service Authorization Specialist

Job Description

Job Description

This position will serve the Christiansburg, Lynchburg, or Roanoke location.

JOB SUMMARY:
As a Service Authorization Specialist, you will play a critical role in managing service authorizations and maintaining accurate records within the ADS program in our organization. You'll be responsible for managing the Medicaid/MCO service authorization process for Agency-Directed services provided by the organization and ensuring compliance with regulatory requirements for DePaul Community Resources. This position is a hybrid position, with some work done in the office and some from home.

SUPERVISION RECEIVED AND EXERCISED:
The ADS Service Authorization Specialist reports directly to the Director of Agency-Directed Services.

ESSENTIAL FUNCTIONS AND DUTIES:
This list is not an exhaustive & all-inclusive list of job responsibilities. The distribution of time allotted for any function or duty is subject to change with or without notice. Nothing in this job description restricts management's right to assign other responsibilities to this job or reassign them elsewhere at any time.

Service Authorization Management:

• Coordinate and facilitate the authorization process for services rendered to Medicaid and MCO beneficiaries.
• Collaborate with RNs and Case Managers to gather necessary documentation for authorization requests.
• Monitor authorization timelines and ensure adherence to regulatory standards.
• Keep abreast of changes in Medicaid and MCO regulations and update internal processes accordingly.

Insurance Verifications:

• Thoroughly confirm patients insurance coverage, including policy details, copayments, deductibles, and any prior authorizations required for services
• Analyze policies to ensure they meet the necessary criteria for authorization and billing purposes
• Ensure the company's services are within the patient's insurance network by conducting thorough checks during insurance verifications, confirming in-network status for services rendered.

Communication and Collaboration:

• Communicate effectively with internal teams and external agencies to resolve authorization or credentialing issues.
• Collaborate with other departments to streamline processes and improve efficiency in authorization and credentialing workflows.

KNOWLEDGE, SKILLS, ABILITIES & OTHER CHARACTERISTICS REQUIRED:
Knowledge, skills, abilities, and other characteristics (KSAOs) are attributes required to perform a job, which are demonstrated through qualifying training, education, and experience. This list is not an exhaustive & all-inclusive list of all KSAOs for this job.

Knowledge of:
Healthcare terminology and Medicaid provider qualifications
Virginia Waiver Management Systems (WaMS)
Kepro/Atrezzo/Acentra portal
Availity portal
Virginia Medicaid Enterprise System (MES)
Credentialing process for Virginia Medicaid Managed Care Organizations (MCOs)
Service authorizations and insurance verifications
Office and records administration techniques and procedures.
Office procedures and spelling, grammar, punctuation, and arithmetic.
The structure and content of the English language, including the meaning and spelling of words, rules of composition, and grammar
Microsoft Office Word, Excel, PowerPoint, Outlook, SharePoint, Teams, and virtual meeting applications such as Zoom
DePaul's policies, procedures, and standard practices and the rules and guidelines established by regulatory and governing agencies such as DBHDS (Department of Behavioral Health & Developmental Services), HCBS (Home Community Based Services, VDH (Virginia Department of Health), DSS (Department of Social Services, and DMAS (Department of Medical Assistance Services)
Policies, procedures, and strategies that promote the safety and protection of people, data, and property

Skill in/Ability to:
Proficiency in using database systems and software for credentialing and authorization processes
Work independently and collaboratively in a fast-paced environment while maintaining accuracy and attention to detail
Complete required training as needed and assigned
Give full attention to what other people are saying, take time to understand the points being made, ask questions as appropriate, and not interrupt at inappropriate times
Demonstrate verbal and written communication and body language that conveys information, ideas, or inquiries effectively and concisely that purveys professional composure, emotional intelligence, thoughtfulness, patience, and respect amidst change, ambiguity, and within the daily trajectories of work
Operate standard office equipment such as telephone, calculator, printer, scanner, cellular phone, tablet, computer, postage machine, shredder
Demonstrate logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
Collect and analyze data
Manage multiple priorities and complete assignments on time, accurately, and with attention to detail, and ensure a high-quality work product
Work collaboratively within a team environment and build strategic relations with coworkers, management, and community partners
Communicate effectively in both oral and written form
Develop objectives, evaluate effectiveness, and assess needs
Recognize, analyze, and problem-solve ambiguous or difficult situations and questions using critical thinking while maintaining professional composure

Other Characteristics:
Demonstrate self-awareness, ongoing self-evaluation, and a commitment to being part of a diverse, equitable, respectful, and inclusive workplace where all people are valued
Demonstrate professional composure in difficult and stressful situations
Demonstrate the FIRST (fairness, integrity, respect, safety, trust) values in the daily trajectories of work
Demonstrate professionalism regarding access to sensitive and confidential information related to employees, clients, and business records, with no disclosure to others without needing to know

MINIMUM REQUIREMENTS TO APPLY:

• High school diploma or G.E.D., and experience working with medical billing and Medicaid regulations required
• Education in Healthcare Administration, Human Services, or a related field, or equivalent work experience in Medicaid service authorization and credentialing preferred

WORK ENVIRONMENT:
The work environment characteristics described herein represent those an employee encounters while performing the essential functions of the position. The employee regularly works in an office environment and occasionally in the field. Work is generally completed regularly during weekdays; however, daily work hours may vary. Completion of job duties outside of normally scheduled hours may be required. Work is subject to frequent interruptions, and noise levels vary based on the work locations.

PHYSICAL REQUIREMENTS:
The physical demands described herein are representative of those that an employee in this position must meet, with or without reasonable accommodations, to perform the essential functions successfully. Physical activities required are finger dexterity necessary to operate equipment used in the position, effective communication, and seeing or hearing verbal cues. Walking for up to one-third of the time, sitting two-thirds or more of the time, standing for up to one-third of the time, bending from one-third to two-thirds of the time, stooping for up to one-third of the time, lifting/pushing/pulling no more than ten pounds is required. When accessing various locations, the incumbent must climb stairs and ramps. This position requires driving approximately ten percent of the employee's working time to various locations. Public transportation may not be available. Individuals needing reasonable accommodations should speak with their immediate supervisor/hiring manager.

SPECIAL REQUIREMENTS AND QUALIFICATIONS:
Successful completion (per DePaul's policies) of a Motor Vehicle Record, Criminal and Child Protective Services Background Report, and Drug Test is required. An unsatisfactory result of any of these tests will terminate the application process.

NOTE:
This description provides information regarding the essential functions of the designated job and the general nature and level of work associated with the job. It should not be interpreted to describe all the duties whose performance may be required of such employees or be used to limit the nature and extent of assignments such an individual may be given.

DePaul is an Equal Opportunity Employer and E-Verify Participant.

Flexible work from home options available.