Position Purpose:
Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
Education/Experience:
Requires a High School diploma or GED
Requires 1 2 years of related experience
Knowledge of medical terminology and insurance preferred.
Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment
Performs data entry to maintain and update various authorization requests into utilization management system
Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer
Remains up-to-date on healthcare, authorization processes, policies and procedures
Performs other duties as assigned
Complies with all policies and standards
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
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"Position Purpose:
Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
Education/Experience:
Requires a High School diploma or GED
Requires 1 2 years of related experience
Knowledge of medical terminology and insurance preferred." "Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment
Performs data entry to maintain and update various authorization requests into utilization management system
Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer
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 Business Group & Key Projects |
- Health plan or business unit
- Team culture
- Surrounding team & key projects
- Purpose of this team
- Reason for the request
- Motivators for this need
- Any additional upcoming hiring needs?
| - Sunshine State Health Plan
- They will be responsible for reviewing the tasks in the que
- Processing member approvals to match them with a provider
- the performance expectations/metrics for this individual and their team:
95% on audits/ 2% error rate
|
| Typical Day in the Role |
- Daily schedule & OT expectations
- Typical task breakdown and rhythm
- Interaction level with team
- Work environment description
| Remote FL must reside in Florida
Monday Friday 8 am 5 pm (1) hour lunch
Family style environment
Remote work |
| Compelling Story & Candidate Value Proposition |
- What makes this role interesting?
- Points about team culture
- Competitive market comparison
- Unique selling points
- Value added or experience gained
| The team supports their own team
There is a group chat where everyone can ask questions
Each team has their own smaller group to connect and discuss with their manager
Open communication enjoyable environment
Management Team dedicated to team advancement |
| Candidate Requirements |
| Education/Certification | Required: High School Diploma | Preferred: n/a |
| Licensure | Required: n/a | Preferred: n/a |
- Years of experience required
- Disqualifiers
- Best vs. average
- Performance indicators
| Must haves: - Microsoft Experience (excel experience) - team has seen in previous hires issues with not knowing how to navigate a spreadsheet(s). Must know how to log into platforms, use of TEAMS would be helpful Microsoft Office Platform
- Customer Service Experience along the same lines as the field
- Authorizations and Compliance experience
Nice to haves: - Healthcare background
- Trucare (Centene program)
Disqualifiers: - Not knowing how to navigate through Microsoft office
Performance indicators: |
- Top 3 must-have hard skills
- Level of experience with each
- Stack-ranked by importance
- Candidate Review & Selection
| 1 | Microsoft Experience (excel experience) - team has seen in previous hires issues with not knowing how to navigate a spreadsheet(s). Must know how to log into platforms, use of TEAMS would be helpful Microsoft Office Platform
|
| 2 | Customer Service Experience along the same lines as the field
|
| 3 | Authorizations and Compliance experience
|
| Candidate Review & Selection |
- Shortlisting process
- Second touchpoint for feedback
- Interview Information
- Onboard Process and Expectations
| Projected HM Candidate Review Date: | 24 48 hours |
| Number and Type of Interviews: | Teams |
| Extra Interview Prep for Candidate: | n/a |
| Required Testing or Assessment (by Vendor): | n/a |
| Manager Communication Preferences & Next Steps |
- Background Check Requirements (List DFPS or other specialty checks here)
| n/a |
- Do you have any upcoming PTO?
| March 25 - 30 |