Community Service Board of Middle Georgia · 23 hours ago
UM/Data Specialist
Dublin, GA
Full-time
Onsite
New Grad, Entry Level
$17/hr - $17/hrThe Community Service Board of Middle Georgia is dedicated to providing quality innovative behavioral healthcare and is searching for a Utilization Management/Data Specialist for the HOPE IC3 Program. The role involves ensuring that Medicaid and other authorizations are handled appropriately and within deadlines, while also collaborating across departments to maintain accurate data and communication regarding authorizations.
Mental Health Care
No H1B
Responsibilities
Complete authorization service summaries for C&A, EA and IC3 CMO consumers in a timely manner as additional units are needed or when authorization dates end
Send CMO OTR summary authorization requests for C&A and EA to B12 UM department for submittal
Submit GAMMIS for IC3 CMO consumers
It is required that summaries are completed and submitted before authorization expires or units are out
For APS Medicaid/FFS/State Contracted consumers an ASO must be completed as additional units are needed or authorization expires. ASOs need to be completed no later than 5 days after additional service is needed
Will submit ASO’s and provided documents for CMO’s, Medicaid/FFS/State Contracted consumers via GAMMIS for Autism services
Sill submit ASO’s for Medicaid/FFS/SCS consumers via CareLogic for IC3 services
Will communicate with UM department B12 immediately via email when receiving an authorization or a denial by phone or email concerning consumers in all programs
Will check UM reports from Tanika and other UM members to ensure that no insurances have been discontinued or changed. When insurance changes will immediately work toward getting OTRs completed the same day for CMO insured individuals and within 24 hours of cases who require an ASO to be completed
Will track dates that authorizations are submitted to UM department and notify UM/Program Director/case manager if authorization requests are not answered by CMO/APS within 10 days of request
Will maintain accurate authorization of unit’s system and will check for accuracy and for need of additional service request summaries on a daily basis
Will gather summary information needed from case managers/program directors and will develop summaries to be submitted for authorizations. Will ensure that all pertinent information is included on summaries
Will communicate with manager, program managers and program coordinator when trends or problem arise which hinder the authorizations to be completed
Will consistently work reports submitted from UM and reports in Avatar as needed, to ensure that authorization issues are resolved and that changes are made to ensure that the billing instances for services rendered have no issues
Will regularly check payor sites and with UM for any changes affecting authorization for services. Will communicate current information with coordinator, managers, and direct service staff
Will ensure that all current plans are complete and available prior to requesting authorization for services. Will maintain clear and timely communication with schedulers, managers, and direct service staff regarding any required updates, scheduling needs, or issues that may hinder the authorization process
Assist managers with assigned projects, data collection and other task as needed
Participate in LOC meeting and Denial Review meetings as needed
All other duties as assigned
Qualification
Required
High School Diploma/GED (or equivalent)
Previous experience working with qualitative data and research
Proficiency in Microsoft Office products
Attention to detail and problem-solving skills
High level of professionalism
Strong written and verbal communication skills
Excellent time management & organizational skills
Preferred
Bachelor's degree in a related field preferred
Benefits
Medical, Dental & Vision Plan Options!
Generous Paid-Time Off Policy with Flexibility Companywide!
401(k) Plan with Company Match!
Short- & Long-Term Disability Plans!
Access to our Employee Assistance Program (EAP)!
Paid Training Time!
Opportunities for Career Growth & Advancement!
Paid Lunch Breaks& So Much More!
Company
Community Service Board of Middle Georgia
5001-10000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase