Service Authorization Specialist

    • Job Tracking ID: 512507-787835
    • Job Location: Milwaukee, WI
    • Job Level: Entry Level (less than 2 years)
    • Level of Education: High School/GED
    • Job Type: Full-Time/Regular
    • Date Updated: November 30, 2021
    • Years of Experience: Up to 2 Years
    • Starting Date: ASAP
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Job Description:

Be Part of a Great Team!

Independence First is looking for awesome people to join our team!

You are just the person to join our growing team if you are...

* Looking for an Excellent Benefits Package

* Passionate About Helping Others

* Prefer Bilingual in English, Spanish, Hmong or Arabic (Not required)

Benefits include:

* 12 sick days, 13 vacation days and an additional 11 paid holidays a year

* Employer paid Dental, Life Insurance (twice annual salary), AD&D, Short and Long Term Disability

* Health Insurance Benefits (partially employer paid, depending on coverage)

* Low-cost Vision Insurance

* Employer-matched 403(b) Retirement Account

* Fitness Center On-site

* Annual Health Risk Assessment

* Annual Flu Shot

* Comprehensive Wellness Program

* Tuition Reimbursement Program

Position: Service Authorization Specialist, Personal Assistance Services

Status: Full-Time, Hourly

Reports to: Personal Assistance Services Manager

Position Summary: Responsible for the administration of consumer prior authorizations, re-certification and consumer eligibility and reimbursement to ensure continuous service.

Position Expected Hours of Work: This is a Full-Time position. Days and hours of work are Monday through Friday, 8:00 am to 4:30 pm. Occasional evenings and weekends.

Essential Functions of the Position:

  1. Responsible for verification of insurance eligibility on a monthly basis and efficient follow up.
  2. Responsible for data entry of Personal Care Screening Tool.
  3. Responsible to submit and track prior authorizations to all payer sources contracted with the PAS Program and document appropriately in designated databases.
  4. Communicate with Medicaid, Long Term Care Programs (family Care, Partnership and IRIS) and Managed Care Organizations to ensure authorizations are correct and received in a timely manner.
  5. Maintains on-going knowledge of payor source requirements.
  6. Communicate with Care Coordinator to resolve conflict between the Long Term Care Functional Screen and the Personal Care Screening Tool.
  7. Responsible for submitting and tracking the 485 MD orders and ensuring that the documents are signed and received prior to the beginning of the certification period.
  8. Communicate with Care Coordinators regarding care problems/situation on an ongoing basis.
  9. Requests for medical records/documentation as needed for prior authorizations and hospital verification requests.
  10. Responsible for variety of tasks associated with the operation of the PAS department.
  11. Must have a firm belief in consumer control, the Independent Living Philosophy and Independence First’s Vision Statement.

Work Environment

  1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  2. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

he above statements reflect the general details necessary to describe the principle functions of the occupation described and shall not be construed as a detailed description of all the work requirements that may be inherent in the occupation.

As an Independent Living Center, it is required that 51% of Independence First’s staff have a disability. Independence First is an equal opportunity employer and strongly encourages people with disabilities to apply for this position.

Experience and Skills:

Professional Qualifications

  1. High School Diploma or equivalent.
  2. Minimum of one year of experience working with Forward Health, Medicaid Insurance Eligibility and Prior Authorization preferred.
  3. Excellent organization and interpersonal skills, excellent written and verbal communication skills required; very detail oriented.
  4. Ability to be flexible and multitask to meet the changing needs of the department required.
  5. Positive attitude and a team player.
  6. Considerable knowledge of medical terminology.
  7. Considerable knowledge and experience in the use of MS Office (Word, Excel, Outlook, Access)
  8. Knowledge of Medicaid regulations in regards to the provision of Personal Care Services, as well as criteria for Medicaid Managed Care and Self Directed Supports preferred.
  9. Ability to problem solve and has conflict resolution skills.
  10. Ability to be highly sensitive to persons with disabilities.