HSCSN Pre-Authorization Asst

30030 Health Services for Children with Special Needs, Inc.; United States; Presencial; USD 27.000 - 45.000; Tempo integral

Resumo da vaga

Health Services for Children with Special Needs, Inc. (HSCSN) is seeking an Utilization Management Support Specialist in Washington, DC to assist UM Review staff.

You will manage the department's main phone line, route calls, create authorization shells, and attach relevant documents to the HSCSN electronic record. The role requires a high school diploma (associate degree preferred), 2 years in managed care, strong knowledge of medical terminology, and excellent written and verbal communication.

Qualificações

• High School Diploma or GED required.
• Associate's Degree preferred.
• 2 years related experience in managed care preferred.
• Knowledge of medical terminology.
• Strong written and oral communication skills.

Responsabilidades

• Obtains clinical information required for review and documentation of precertification requests and routes to the appropriate individuals for processing.
• Monitors fax machines, faxes queues, and mail for authorization/reauthorization requests and routes information to the appropriate individuals promptly.
• Receives calls from enrollees and providers, assesses nature of call and completes requests.
• Answers inquiries from enrollees/caregivers and providers, and routes to appropriate review nurse or Chief Medical Officer.
• Enters authorizations and/or provides service authorizations to vendors as requested by clinical staff.
• Communicate authorization information to vendors timely and accurately.
• Documents all relevant information and communication in the HSCSN IT system.

Conhecimentos

Medical terminology

Team collaboration

Written and verbal communication

Organization

Microsoft Office

Formação

High School Diploma or GED

Associate's Degree

Ferramentas

HSCSN EMR system

Descrição da vaga

1101 Vermont Ave NW Suite 1200 Washington, DC 20005 Kids Are Our Everything. Department 10522 HSCSN - Utilization Management Pay Range $19.65 - $32.75

Works under the direction of the Director of Utilization Management and UM Review staff. Provides support to UM Reviewers by:

• managing the UM Department's main phone line and transfers calls to appropriate staff as indicated
• opening UM cases by creating authorization shells in the HSCSN electronic Record
• sending requests for review to the appropriate UM reviewer based on service being requested and attaching documents related to UM activities to the HSCSN electronic record

Minimum Education

• High School Diploma or GED (Required)
• Associate's Degree (Preferred)

Minimum Work Experience

• 2 years related experience in managed care. (Preferred)

Required Skills/Knowledge

• Knowledge of medical terminology
• Demonstrated skills and ability to work collaboratively in a team environment
• Strong written and oral communication skills
• Strong organizational skills
• Computer literate in Microsoft suite

Required Licenses and Certifications

• Driver's License (Preferred)

Job Functions

• Obtains clinical information required for review and documentation of precertification requests and routes to the appropriate individuals for processing.
• Monitors fax machines, faxes queues, and mail for authorization/reauthorization requests and routes information timely to the appropriate individuals for processes.
• Receives calls from enrollees and providers, assesses nature of call and completes requests.
• Answers inquiries from enrollees/caregivers and providers, and routes to appropriate review nurse or Chief Medical Officer.
• Assist clinical staff identifying and securing vendors for services requiring prior authorization (home health, supplies, durable medical equipment, etc.).
• Enters authorizations and/or provides service authorizations to vendors as requested by clinical staff.
• Communicate authorization information to vendors timely and accurately.
• Documents all relevant information and communication, links documents or other information in the HSCSN IT system.
• Seeks advice from UM Director or other designated person(s) with expertise in specialty areas when necessary.
• Effectively resolves inquires related to status of authorization requests.
• Provides accurate and timely documentation to care management staff in the IT system.
• Identifies and seeks guidance for potential risks and utilization concerns.
• Demonstrates compliance with authorization timeliness and case closure.
• Documents according to policy as it related to authorization process.
• Researches and answers provider and vendor authorization inquiries.
• Demonstrates customer service, evidenced by no reports of complaints, or non-responses to e-mails or phone calls.
• Demonstrates compliance with work flow and department processes.
• Demonstrates customer service, and phone etiquette.
• Demonstrates time and attendance.
• Other job duties: May perform other duties in addition to those outlined in this job description.

The disclosed salary range includes the minimum and maximum rates within which Children's National believes an individual’s base pay rate will fall for this position. It is not typical for an individual to be hired at or near the maximum of the pay range. The exact pay rate for this position will be based on a variety of factors in alignment with the Children's National compensation philosophy. These factors are legitimate and non-discriminatory including, but not limited to, the current market conditions; organizational needs; the individual’s combination of prior work experience, level of education, knowledge, skills, and other qualifications. Children’s National is committed to providing a fair and competitive total rewards package to each of our employees. This base salary range does not include our comprehensive benefits package or any additional compensation for which this position may be eligible.

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.

The "Know Your Rights" poster is available here: and the pay transparency policy is available here: Know Your RightsPay Transparency Nondiscrimination Poster.

Please note that it is the policy of Children's National Hospital to ensure a "drug-free" work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.

About Us

Health Services for Children with Special Needs, Inc. (HSCSN) is the managed care plan contracted with the District of Columbia to administer the Child and Adolescent Supplemental Security Income Program (CASSIP) for children and young adults to age 26 years. HSCSN's mission is to coordinate innovative, high-quality, community-based care for individuals with complex needs and their families. HSCSN empowers all we serve to improve the quality of their lives. For more information about HSCSN, visit the website: HSCSN Health Services for Children with Special Needs | Health Services for Children with Special Needs, Inc. (HSCSN) (hscsnhealthplan.org)