Authorization Specialist

About Claratel Behavioral Health

Claratel Behavioral Health is an innovative, community-based behavioral health and developmental disabilities services organization offering a full range of mental health, developmental disabilities, and substance use disorder services to underserved individuals. As a public, not-for-profit organization, Claratel Behavioral Health operates in more than 20 locations in DeKalb County, Georgia, with a diverse workforce of more than 400 direct-care and support staff.

If you are passionate about driving change in behavioral health and developmental services and are eager to work in an environment that values innovation and inclusivity, Claratel Behavioral Health is the place for you. Here, your work is impactful, your growth is prioritized, and your well-being is supported. Together, we can forge pathways to a healthier future for all.

The Authorization Specialist will be responsible for the daily processing of all authorization files/requests on a daily basis. Works closely with each clinician on any requests that are on review. Ensures all behavioral health programs are obtaining and submitting authorizations in a timely fashion. Assists clinicians with questions or concerns they may have regarding authorizations. Oversees and works on all authorization related issues. Conducts training on CMO authorizations, ASO related issues, coding/billing updates and eligibility issues. Creates reports for managerial staff to summarize errors.


DUTIES & RESPONSIBILITIES:


Under general supervision, incumbent duties and responsibilities will include but is not limited to the following:
• Coordinate/manage all ASO and Care Management Organization (CMO) authorization requests for DeKalb CSB
• Oversees the authorization process end to end making changes as identified and resolving of billing discrepancies
• Electronically submits, receives, and process data on a daily basic. Analyzes reports and correct errors and/or inform appropriate staff of error to be corrected and re-submit
• Review documentation and coordinate with clinical team members to ensure the State and CMO clinical requirements/standards are being met
• Coordinate with the UM Manager regarding any authorization reviews and appeals
• Use advanced tools to analyze data and conduct comprehensive clerical research using a variety of resources to generate reports and responds to requests
• Enter data from forms, records, and/or reports using a computer or terminal. Code information as appropriate


SKILLS AND EDUCATION REQUIREMENTS:
• Demonstrate overall knowledge of authorization and claims processing for insurance companies and plans both private and government.
• Demonstrate the ability to make decisions, assess, and resolve problems effectively.
• Demonstrates the ability to maintain the confidentially of all records
• Demonstrated ability to manage multiple tasks and demands given tight times constraints while ensuring a high degree of accuracy and attention to detail.
• Effective interpersonal skills in a diverse population
• Ability to interpret and apply agency policies and procedures
• Ability to communicate effectively, both orally and written
• Ability to establish and maintain effective working relationships with others
• Completion of an associate's degree from an accredited college or two years of related experience
• Experience with SFTP protocols
• Microsoft Excel- creating spreadsheets, filtering, and pivot tables
• Microsoft Word- creating error templates and documentation


Pre-employment drug screening and successful completion of a criminal history background check is required.

Claratel Behavioral Health participates in E-Verify (Company ID: 226305)

Claratel Behavioral Health is an Equal Opportunity Employer. Candidates who may require an accommodation under the Americans with Disabilities Act or similar law to perform the essential functions of this job are encouraged to contact Human Resources at View email address on click.appcast.io.