Authorization Eligibility Specialist

POSITION TYPE: HYBRID 

Salary Range: $40,670 - $59,700

POSITION SUMMARY

The Authorization/Eligibility Specialist is assigned to the Continuous Quality Improvement Program and provides support to the CQI and Billing Teams. The primary responsibility of this role is to complete and maintain CCI’s program authorizations. This position requires the use of external electronic payer records/authorization management systems.

KEY RESPONSIBILITIES

· Authorization Management Activities including monitoring of required clinical documentation, tracking and performing data entry, transposing to CCI system, editing, adjustments and monitoring of the identified authorization process/system.

· Provides team technical support by problem solving denials, pending authorizations, suspense issues and clinical discrepancies.

· Supports insurance eligibility through data entry, monitoring, tracking and coordination with treatment teams.

· Support Clinical teams with census management activities including processing program enrollments and disenrollments.

· Participates in program meetings as well as routine supervision to stay abreast of agency and program developments.

· Supports special projects as assigned

In addition to role responsibilities, each staff member of Community Connections has the following responsibilities as a part of their employment:

· Models and reinforces Community Connections mission to provide behavioral health, residential services, and primary health care coordination for marginalized and disenfranchised women, men, youth, and children living in the District of Columbia, many of whom are coping with challenges including mental illness, addiction, and the aftermath of trauma and abuse.

· Models and reinforces Community Connections values of quality, innovation, respect, equity, and integrity daily.

· Reinforces Community Connection’s commitment to diversity, equity, and inclusion.

· Protects the privacy of our consumer’s protected health information by maintaining compliance with HIPAA and other relevant CC related IT security regulations.

· Completes and stays current on role specific and organizational wide training.

· Performs other duties as assigned on an as-needed basis.

DESIRED KNOWLEDGE/SKILLS/ABILITIES:

· Bachelor’s or master’s degree in social work, psychology, or relevant human services discipline or 5 years working within a behavioral health system of care.

· Possession of exceptional organizational, problem-solving, as well as verbal and electronic communication skills.

· Ability to work effectively and collaboratively with other agency programs in a supportive and respectful manner.

· Possess good computer skills and the ability to navigate and problem-solve in multiple electronic health care systems, software and web-based programs.

· Basic understanding of the connection between the billing/authorization process and diagnostic/clinical information and basic working knowledge of the DSM, medications, housing system, and other social services resources.

· Familiarity with the concept of medical necessity and level of care required and it’s impact to authorization and billing

Salary : $40,670 - $59,700