Position Purpose: Supports the prior authorization request to ensure all authorization requests are addressed properly and in the contractual timeline. Aids utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access. Supports authorization requests for services in accordance with the insurance prior authorization list Supports and performs data entry to maintain and update authorization requests into utilization management system Assists utilization management team with ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines Contributes to the authorization review process by documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination Remains up-to-date on healthcare, authorization processes, policies and procedures Performs other duties as assigned Complies with all policies and standards | ||||||
| Story Behind the Need | ||||||
| This team will be responsible for redirecting Out of Network authorizations to In Network providers. Driving the request: There is an anticipated large volume of requests that will need to be redirected as a Northwell Health Network that may be non-renewed. | |||||
| Typical Day in the Role | ||||||
| Hired Candidates will be working from a queue of received authorizations. The cases may be received via Outlook or FileNet. The candidate will document in Facets. They will be required to make outreach to providers and members, generate letters. The performance metrics is approximately 1.5 cases/hour. | |||||
| Candidate Requirements | ||||||
| Education/Certification | Required: High School Diploma | Preferred: | ||||
| Licensure | Required: n/a | Preferred: | ||||
| Years of experience required: 1-2 years auth specialist roles/prior auth experience - Understanding of medical terminology and insurance with phone etiquette Disqualifiers: Not having a professional environment to work remotely, not having reliable internet (please use hotspot or get to a secure place with wifi to continue working) Additional qualities to look for: Prior Facets experience, knowledge of clinical terminology, prior office or insurance experience | ||||||
| 1 | Tech savvy, ability to work in multitask in multiple systems at once while speaking | ||||
| 2 | Strong communication skills, written and verbal, phone etiquette | |||||
| 3 | Documentation skills | |||||
| Candidate Review & Selection | ||||||
| Projected Manager Candidate Review Date: | 24-48 hours | ||||
Type of Interviews: | Teams CAMERA ON (Please be ready to interview/ ATTIRE AND LOCATION) | |||||
| Required Testing or Assessment (by Vendor): | ||||||
| Next Steps | ||||||
| Outlook Calendar is up to date | |||||
| Todd Charland | |||||