Kansas Works Jobs

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/12939817

Description

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POSITION RESPONSIBILITIES:

• UTILIZATION MANAGEMENT FOR OUTPATIENT CLINICIANS

  • Responsible for organizing and monitoring utilization management functions under the Utilization Management plan and pertaining to patients under the third party payer system for the outpatient services, including psychological testing, in the tri-county offices in Newton, Hillsboro and McPherson.

  • Demonstrate knowledge and ability to professionally and effectively communicate, orally and written, to all customers in the organization by:

    • Providing well-written, accurate, and timely communication.

    • Providing reports with timely information and in a current and appropriate format.

    • Ability to write appeal/reconsideration letters, if needed.

  • Demonstrate knowledge and skills of the requirements for Utilization Management for federal and state (Medicare, Medicaid), private third party payers, and managed care by monitoring current outpatient authorizations and requesting new and/or renewal authorizations.

  • Submit applications for Substance Use Disorder (SUD) patients authorizations to obtain AAPS funding for those patients.

  • Follow through routinely to assure that requested authorizations are received; respond to requests for further documentation as needed until authorizations are completed.

  • Work the Claim Follow-Up Report for authorizations weekly as received. Resolve claim denials and resend report to RCM for further action.

  • Demonstrate basic knowledge and application of personal computer technology, including spreadsheets and Word documents.

  • Coordinate with Prairie View\'s billing department and access necessary information when required.

  • Regularly communicate with insurance/managed care companies, health information management, Patient Accounts Specialists, and therapists to assist in assuring optimal reimbursement for services rendered.

  • Consistently notify providers when authorization is denied; discuss further options if needed.

  • Daily contact insurance/managed care companies with treatment plan, diagnosis, symptoms, and other needed information in order to obtain authorization of treatment; obtain forms and assist in completing them as needed.

  • Daily document all contacts with managed care companies in the computer accurately.

  • Contact providers with any special instructions to maintain consistent authorizations. Ask provider to contact insurance company when treatment plan is unavailable or managed care companies request contact with provider.

  • Daily review computer-generated outpatient utilization review reports and enter updated information accurately.

  • Assure that authorizations which cannot be backdated are received by the date of service.

  • Communicate regularly with Patient Accounts Specialists when charges are denied. Resolve issues so the date of service will be paid.

  • Daily enter data of written authorizations received in the mail by insurance companies in clear and concise language.

• MISCELLANEOUS DUTIES
• QUALITY ASSURANCE & PERFORMANCE IMPROVEMENT (QAPI)
• PROFESSIONAL DEVELOPMENT
• EMPLOYEE CONTRIBUTES TO POSITIVE WORK ENVIRONMENT WITH CO-WORKERS AND CUSTOMERS

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Qualifications

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Minimum Education: High school degree required

Minimum Experience: One year office experience

Must have prior computer experience

Must have good listening, verbal and written communication skills

Must be able to understand, organize, synthesize, and communicate critical medical

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