Clinical Authorization Specialist (Remote)
The Clinical Authorization Specialist, reporting to the Manager, Authorizations, will complete Medicaid authorization requests, Illinois Medicaid Comprehensive backssment of Needs and Strengths (IM+CANS) reviews.
ESSENTIAL DUTIES & RESPONSIBILITIES Complete and review Medicaid Authorization requests. Ensure compliance, accuracy, timeliness,
and appropriate documentation. Review member IM+CANS, Psychiatric Evaluations, Co-occurring backssments, Service Notes, and any additional documentation to effectively complete Authorization requests Coordinate with treatment teams to gather additional clinical information necessary to complete authorizations accurately and thoroughly Communicate with insurance companies for status or issues on requests submitted Complete appeals for denials in a timely manner Thoroughly review reports for expiration dates and remaining units to ensure authorizations are completed and submitted in a timely manner Advise direct service staff regarding appropriate procedures or practices in response to completion of Authorization and IM+CANS documentation Develops and deploys training materials to decrease # of errors and omissions in documentation that result in rejected billing Assist in IM+CANS review and signature process.
Ensure compliance, accuracy, timeliness, and appropriate documentation EDUCATIONMust, at a minimum, meet Office of Mental Health Rule 132 credential requirements for a Mental Health Professional including a Bachelor's in social work, counseling, psychology or closely related field. EXPERIENCE Familiarity and working knowledge of Clinical Operations and Quality Operations. Non-Profit and/or health care experience preferred. Committed to achieving results under demanding time frames. Covid-19 Note In the spirit of caring for one another and our community, please note that upon accepting an offer of employment from Thresholds, you will be required to share proof of a Covid-19 vaccination.
The requirement is subject to accommodation in compliance with applicable laws and regulations. Associated topics: accounts receivable, authorization, biller, cbo, collection, data, desk, insurance, medical coding, number
Location: Chicago, IL