What are the responsibilities and job description for the Prior Authorization Specialist - Springfield position at fgcinc?
Job Description:
Family Guidance Centers, Inc. (FGC), a not-for-profit behavioral healthcare organization, treats and prevents substance use disorder, as well as an array of other related problems. Since 1969, FGC’s comprehensive programming has educated and guided individuals toward their full potential as productive members within their own families and our society. Family Guidance Centers, Inc seeks to support the behavioral health of individuals, families, and communities through our commitment to innovation, accountability, and compassionate care to facilitate positive, lasting change.
All external candidates are eligible for our Sign-On Bonus.
****$1,000 SIGN ON BONUS****
1st $500.00: after 30 days of employment
2nd $500.00: after 6 months of employment
ESSENTIAL DUTIES AND RESPONSIBILITIES:
• Monitors adherence to FGC Springfield’s utilization management plan to ensure the effective and efficient use of services.
• Monitors the appropriateness of admissions, continued stays, and discharges.
• Monitors patient records for DASA, Joint Commission, and CARF compliance.
• Obtains authorization for services as necessary.
• Performs concurrent reviews for patients to ensure that continued stays are justified and properly documented in the patient’s record.
• Reviews patient records for accuracy, timeliness, appropriate admission, continued stay, discharge, and overall content.
• Obtains pre-authorizations for treatment services from Managed Care Organizations or other payors according to established procedures.
• Reviews the lengths of stay, continued-stay days, and other relevant chart documentation for patients to ensure appropriateness of level of care.
• Refers to Program Managers and supervisor all cases that do not meet established guidelines for admission, continued stay, and discharge, and/or for DASA, Joint Commission, or CARF compliance.
• Identifies problems related to the quality of patient care and refers such problems to Program Managers and supervisor.
• Monitors group size and adjusts schedule based on size and other factors, as needed.
• Compiles monthly auditing reports and statistics for presentation to supervisor.
• Reviews patient records for Infection Control issues and reports to Safety Committee.
• Assists with toxicology specimen collection.
• Expected to develop a working knowledge of FGC Standard Operating Procedures, and all applicable licensing rules and regulations.
• Participates in agency wide training, retreats and Performance Improvement programs.
• Maintains patient confidentiality in accordance with regulations.
Work Location: 120 North Eleventh St Springfield, IL 62703
Schedule: Monday through Friday 6:00am-2:30pm, and available for Saturday coverage as needed.
Number of Openings: 1
Salary: $20 hourly
Family Guidance Centers, Inc is a Drug Free Environment, an Equal Opportunity Employer.
Experience and Skills:
EDUCATION AND/OR EXPERIENCE: B.A. preferred or equivalent experience. One year of UR or clinical experience preferred.
CERTIFICATES, LICENSES, REGISTRATIONS: CADC preferred
Salary : $20