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Clinical Prior Authorization Representative

Date: Oct 21, 2021

Location: Any city, IN, US, 99999

Company: Gainwell Technologies LLC

The Medicaid Clinical Prior Authorization Representative is responsible for taking incoming calls, providing excellent customer service, working prior authorization, and ensuring that quality and timeliness standards are achieved.

POSITION SUMMARY:

 

The Medicaid Clinical Prior Authorization Representative is responsible for taking incoming calls, providing excellent customer service, working prior authorization, and ensuring that quality and timeliness standards are achieved.

 

PRIMARY RESPONSIBILITIES:

  • Assist members and providers with clinical prior authorizations based on the State's policies and procedures and approved clinical practice guidelines and review criteria.
  • Responsible for ensuring the appropriate medical record documentation is received for all clinical prior authorizations.
  • Responsible for meeting turnaround times and other quality measures on a routine basis.
  • Responsible for referring prior authorization requests for MDR review as appropriate.
  • Responsible for reaching goals and quality on a daily basis.
  • Other duties as assigned.


KNOWLEDGE, SKILLS, & ABILITIES:

  • Ability to solve practical problems and deal with a variety of concrete variables in situations where some standardization exists;
  • Ability to collect and analyze data, draw valid conclusions and actively contribute to the strategic interventions that support the departmental goals.
  • Solid interpersonal skills
  • Strong communication skills
  • Impeccable professionalism and respect to all individuals
  • Must demonstrate strong organizational skills; attentiveness to details; highly motivated with the ability to multi-task.
  • Ability to communicate, facilitate and problem- solve with internal and external customers
  • The ability and willingness to work as a team player.
  • The ability to manage time and prioritize tasks.
  • Must work independently as well as collaboratively within a team.


QUALIFICATIONS:

  • RN or LPN with equivalent work experience.

 

EXPERIENCE/TRAINING:

  • Two to three years experience in health care related customer service field.
  • Previous experience with prior authorization/utilization management, preferred