Authorization and Utilization Specialist Who We Are We are a team that is focused on patient care and quality. Behavioral Health Group (BHG), is a leading provider of opioid addiction treatment services.

BHG provides medication assisted treatment and counseling services in a conventional outpatient setting. At BHG, we are committed to the belief that addiction is a brain disease, not a moral failing.

We believe that with hope, respect, and caring, real recovery is possible. Why work at BHG? We grow better together! At BHG we believe in investing in our team members and growing careers through role-based training and promotional opportunities .

Join our team members and thrive in our people first culture that is rooted in diversity and inclusion and offers many other tangible opportunities such as :

• Benefits : Your choice of three different benefits programs including health, life, vision, and dental insurance , a tuition reimbursement program, and 401K discretionary match
• Bonuses : We offer competitive pay, annual increases, bonuses, and certification / license completion
• Paid Time Off : In addition to paid vacation and company holidays , BHG also provides paid time for training, voting, sick or personal time off
• Work / life Balance : Many of our locations offer flexible work schedules
• Additional Benefits : Employee Discount Programs to applicable cell phone services, restaurants, amusement parks, movie theaters and more
• Career Pathing : We are growing and promote from within
• Self - Care : We offer a self-care series as well as an Employee Assistance Program

BHG is the largest network of Joint Commission accredited outpatient opioid treatment and recovery centers operating almost 120 locations in 24 states , and counting.

Please ensure you check out our open opportunities in other locations / states as we offer relocation assistance to help support your career. Responsibilities

• Support the service authorizations for the Michigan Region clinics and PIHP Medicaid contracts, Northern Michigan Regional Entity (NMRE) and Mid-State Health Network (MSHN).
• Manage submissions of service authorizations and follow up processing of approvals by PIHP Medicaid Contracts
• Develop positive working relationships with Government payer clinical staff to promote an understanding of Prior Authorizations requirements and processes
• Complete and thoroughly document all Client Accounts with the approved or denied Authorization as well as clearly communicate the information to clinicians
• Research, follow-up and resolve any open or pending Authorizations Requests with the Government payers in a timely manner
• Communicate with the payers for status updates on all outstanding and pending Authorization Requests
• Track Authorization thresholds on all Government client accounts
• Work with clinician’s on re-Authorization submissions prior to an authorization expiration date, in order to omit any lapses in coverage and maximize billing return
• Work with the Billing Specialist to review explanations of benefits, paying special detail to errors and claim denials in order to resolve any outstanding issues and collect payment
• Assist supervisor in identifying and analyzing patterns of authorization denials and identifying corrective actions or training needs of clinical staff
• Provide clinical staff with support and troubleshooting to assure documentation to support clean authorization submission
• Provide benefits assistance to clinical staff in regards to patient’s outstanding bills and understanding current fees
• Demonstrate intermediate computer / word processing skills
• Perform other duties assigned by the supervisor

Qualifications

• 3-5 years of clinical knowledge in a behavioral health or medical clinic setting
• 3-5 years of prior authorization, insurance verification and benefit verification experience, including navigating via payer portal websites to obtain online benefits
• 2 plus years of high patient volume prior authorization experience
• Ability to read and understand HCFA regulations, HIPPA compliance and updates with each state
• Ability to work independently and under pressure while handling multiple tasks simultaneously
• Basic knowledge of clinical terminology, ICD-10 and CPT codes
• Ability to communicate clearly and effectively verbally and in writing
• Ability to efficiently manage multiple task as assigned
• Ability to adhere to policy and procedures set company wide and inter-departmentally
• Ability to meet production and quality standards set forth by department
• Willing to learn and take on new tasks
• Flexible with assigned tasks
• Be a productive member of the staff
• Demonstrate cooperation

GREAT Opportunities Our Team Members are motivated self-starter’s who excel in a fast-paced environment and become a valued member of our team.

GREAT Support We are committed to providing the training, information, and corporate support necessary to facilitate your success BHG is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity / expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law.

Last updated : 2024-05-03