ADS Service Authorization Specialist
Full Time • Hybrid - US
Responsive recruiter
ADS Service Authorization Specialist
Full-time: 37.5-hour workweek
Location: Hollins-Roanoke office
Full-time: 37.5-hour workweek
Location: Hollins-Roanoke office
JOB SUMMARY:
As a Service Authorization Specialist, you will play a critical role in managing service authorizations and maintaining accurate records within the ADS program in our organization. You'll be responsible for managing the Medicaid/MCO service authorization process for Agency-Directed services provided by the organization and ensuring compliance with regulatory requirements for DePaul Community Resources. This position is a hybrid position, with some work done in the office and some from home.
SUPERVISION RECEIVED AND EXERCISED:
The ADS Service Authorization Specialist reports directly to the Director of Agency-Directed Services.
ESSENTIAL FUNCTIONS AND DUTIES:
This list is not an exhaustive & all-inclusive list of job responsibilities. The distribution of time allotted for any function or duty is subject to change with or without notice. Nothing in this job description restricts management's right to assign other responsibilities to this job or reassign them elsewhere at any time.
Service Authorization Management:
- Coordinate and facilitate the authorization process for services rendered to Medicaid and MCO beneficiaries.
- Collaborate with RNs and Case Managers to gather necessary documentation for authorization requests.
- Monitor authorization timelines and ensure adherence to regulatory standards.
- Keep abreast of changes in Medicaid and MCO regulations and update internal processes accordingly.
Insurance Verifications:
- Thoroughly confirm patients’ insurance coverage, including policy details, copayments, deductibles, and any prior authorizations required for services
- Analyze policies to ensure they meet the necessary criteria for authorization and billing purposes
- Ensure the company's services are within the patient's insurance network by conducting thorough checks during insurance verifications, confirming in-network status for services rendered.
Communication and Collaboration:
- Communicate effectively with internal teams and external agencies to resolve authorization or credentialing issues.
- Collaborate with other departments to streamline processes and improve efficiency in authorization and credentialing workflows.
KNOWLEDGE, SKILLS, ABILITIES & OTHER CHARACTERISTICS REQUIRED:
Knowledge, skills, abilities, and other characteristics (KSAOs) are attributes required to perform a job, which are demonstrated through qualifying training, education, and experience. This list is not an exhaustive & all-inclusive list of all KSAOs for this job.
Knowledge of:
Knowledge, skills, abilities, and other characteristics (KSAOs) are attributes required to perform a job, which are demonstrated through qualifying training, education, and experience. This list is not an exhaustive & all-inclusive list of all KSAOs for this job.
Knowledge of:
- Healthcare terminology and Medicaid provider qualifications
- Virginia Waiver Management Systems (WaMS)
- Kepro/Atrezzo/Acentra portal
- Availity portal
- Virginia Medicaid Enterprise System (MES)
- Credentialing process for Virginia Medicaid Managed Care Organizations (MCOs)
- Service authorizations and insurance verifications
- Office and records administration techniques and procedures.
- Office procedures and spelling, grammar, punctuation, and arithmetic.
- The structure and content of the English language, including the meaning and spelling of words, rules of composition, and grammar
- Microsoft Office Word, Excel, PowerPoint, Outlook, SharePoint, Teams, and virtual meeting applications such as Zoom
- DePaul's policies, procedures, and standard practices and the rules and guidelines established by regulatory and governing agencies such as DBHDS (Department of Behavioral Health & Developmental Services), HCBS (Home Community Based Services, VDH (Virginia Department of Health), DSS (Department of Social Services, and DMAS (Department of Medical Assistance Services)
- Policies, procedures, and strategies that promote the safety and protection of people, data, and property
Skill in/Ability to:
- Proficiency in using database systems and software for credentialing and authorization processes
- Work independently and collaboratively in a fast-paced environment while maintaining accuracy and attention to detail
- Complete required training as needed and assigned
- Give full attention to what other people are saying, take time to understand the points being made, ask questions as appropriate, and not interrupt at inappropriate times
- Demonstrate verbal and written communication and body language that conveys information, ideas, or inquiries effectively and concisely that purveys professional composure, emotional intelligence, thoughtfulness, patience, and respect amidst change, ambiguity, and within the daily trajectories of work
- Operate standard office equipment such as telephone, calculator, printer, scanner, cellular phone, tablet, computer, postage machine, shredder
- Demonstrate logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
- Collect and analyze data
- Manage multiple priorities and complete assignments on time, accurately, and with attention to detail, and ensure a high-quality work product
- Work collaboratively within a team environment and build strategic relations with coworkers, management, and community partners
- Communicate effectively in both oral and written form
- Develop objectives, evaluate effectiveness, and assess needs
- Recognize, analyze, and problem-solve ambiguous or difficult situations and questions using critical thinking while maintaining professional composure
Other Characteristics:
- Demonstrate self-awareness, ongoing self-evaluation, and a commitment to being part of a diverse, equitable, respectful, and inclusive workplace where all people are valued
- Demonstrate professional composure in difficult and stressful situation
- Demonstrate the FIRST (fairness, integrity, respect, safety, trust) values in the daily trajectories of work
- Demonstrate professionalism regarding access to sensitive and confidential information related to employees, clients, and business records, with no disclosure to others without needing to know
MINIMUM REQUIREMENTS TO APPLY:
- High school diploma or G.E.D., and experience working with medical billing and Medicaid regulations required
- Education in Healthcare Administration, Human Services, or a related field, or equivalent work experience in Medicaid service authorization and credentialing preferred
WORK ENVIRONMENT:
The work environment characteristics described herein represent those an employee encounters while performing the essential functions of the position. The employee regularly works in an office environment and occasionally in the field. Work is generally completed regularly during weekdays; however, daily work hours may vary. Completion of job duties outside of normally scheduled hours may be required. Work is subject to frequent interruptions, and noise levels vary based on the work locations.
PHYSICAL REQUIREMENTS:
The physical demands described herein are representative of those that an employee in this position must meet, with or without reasonable accommodations, to perform the essential functions successfully. Physical activities required are finger dexterity necessary to operate equipment used in the position, effective communication, and seeing or hearing verbal cues. Walking for up to one-third of the time, sitting two-thirds or more of the time, standing for up to one-third of the time, bending from one-third to two-thirds of the time, stooping for up to one-third of the time, lifting/pushing/pulling no more than ten pounds is required. When accessing various locations, the incumbent must climb stairs and ramps. This position requires driving approximately ten percent of the employee's working time to various locations. Public transportation may not be available. Individuals needing reasonable accommodations should speak with their immediate supervisor/hiring manager.
SPECIAL REQUIREMENTS AND QUALIFICATIONS:
Successful completion (per DePaul's policies) of a Motor Vehicle Record, Criminal and Child Protective Services Background Report, and Drug Test is required. An unsatisfactory result of any of these tests will terminate the application process.
NOTE:
This description provides information regarding the essential functions of the designated job and the general nature and level of work associated with the job. It should not be interpreted to describe all the duties whose performance may be required of such employees or be used to limit the nature and extent of assignments such an individual may be given.
DePaul is an Equal Opportunity Employer and E-Verify Participant.
The work environment characteristics described herein represent those an employee encounters while performing the essential functions of the position. The employee regularly works in an office environment and occasionally in the field. Work is generally completed regularly during weekdays; however, daily work hours may vary. Completion of job duties outside of normally scheduled hours may be required. Work is subject to frequent interruptions, and noise levels vary based on the work locations.
PHYSICAL REQUIREMENTS:
The physical demands described herein are representative of those that an employee in this position must meet, with or without reasonable accommodations, to perform the essential functions successfully. Physical activities required are finger dexterity necessary to operate equipment used in the position, effective communication, and seeing or hearing verbal cues. Walking for up to one-third of the time, sitting two-thirds or more of the time, standing for up to one-third of the time, bending from one-third to two-thirds of the time, stooping for up to one-third of the time, lifting/pushing/pulling no more than ten pounds is required. When accessing various locations, the incumbent must climb stairs and ramps. This position requires driving approximately ten percent of the employee's working time to various locations. Public transportation may not be available. Individuals needing reasonable accommodations should speak with their immediate supervisor/hiring manager.
SPECIAL REQUIREMENTS AND QUALIFICATIONS:
Successful completion (per DePaul's policies) of a Motor Vehicle Record, Criminal and Child Protective Services Background Report, and Drug Test is required. An unsatisfactory result of any of these tests will terminate the application process.
NOTE:
This description provides information regarding the essential functions of the designated job and the general nature and level of work associated with the job. It should not be interpreted to describe all the duties whose performance may be required of such employees or be used to limit the nature and extent of assignments such an individual may be given.
DePaul is an Equal Opportunity Employer and E-Verify Participant.
Flexible work from home options available.
Compensation: $21.00 - $23.29 per hour
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, age, religion, color, gender, ethnic or national origin, physical or mental disability, marital status, pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, veteran status, sex, sexual orientation, gender identity, gender, genetic information, political affiliation, or any other classification protected by law.
For 40 years, DePaul Community Resources has opened doors to hope and belonging for families and individuals across Central and Southwest Virginia. We are not only a nonprofit human services organization—we are a social impact organization. Every day we work to change the world by improving the lives of children, families, and individuals with developmental disabilities. With dedicated staff, care providers, foster and adoptive parents, and a host of volunteers, advocates, and partners, it is work that we cannot accomplish alone. Hope and belonging is for all of us—with your help, we can make this vision a reality for countless Virginians who cannot imagine it today.
DePaul Community Resources is a nonprofit, 501(c)(3) organization.
All applicants shall be afforded equal opportunity in all aspects of employment, volunteer opportunities, and internships without regard to race, age, religion, color, gender, ethnic or national origin, physical or mental disability, marital status, pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, veteran status, sex, sexual orientation, gender identity, gender, genetic information, political affiliation, or any other classification protected by law. DePaul is an E-Verify employer. The unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace. Failure to comply will result in dismissal from the property and/or employment.
All applicants shall be afforded equal opportunity in all aspects of employment, volunteer opportunities, and internships without regard to race, age, religion, color, gender, ethnic or national origin, physical or mental disability, marital status, pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, veteran status, sex, sexual orientation, gender identity, gender, genetic information, political affiliation, or any other classification protected by law. DePaul is an E-Verify employer. The unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace. Failure to comply will result in dismissal from the property and/or employment.
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