Clinical Intake and Prior Authorization Specialist

Job Description

Job Description

Position Summary:

Conducts client intakes and manages clinical documentation for prior authorization and continued services. May also provide counseling and other clinical services within their scope of practice.

Principal Responsibilities:

• Conduct initial client intakes and other assigned clinical screenings, assessments, and evaluations in a timely, thorough, and clinically appropriate manner.
  
• Complete, update, and maintain clinical documentation required for prior authorization and continued authorization of services, including treatment plans, ASAM assessments and reviews, and other payer- or program-required forms.
  
• Ensure prior authorization documentation clearly supports medical necessity, the recommended level of care, treatment goals, and continued service needs.
  
• Monitor authorization-related deadlines and complete assigned documentation within required timeframes to reduce delays or interruptions in client services.
  
• Collaborate with clinical staff, supervisors, utilization management, billing, and other appropriate team members to obtain information needed for accurate and complete authorization submissions.
  
• Review clinical records for completeness and consistency when preparing prior authorization documentation and communicate identified documentation needs to the appropriate team member or supervisor.
  
• Maintain accurate and timely documentation in the Electronic Health Record and other required systems.
  
• Conduct follow-up assessments, ASAM reviews, treatment plan reviews, and other clinical documentation as assigned.
  
• Evaluate client needs and assist in determining appropriate level of care, program placement, or referrals to other programs or facilities when indicated.
  
• As assigned and based on organizational need, plan, facilitate, and document individual, group, or family counseling sessions within the employee's scope of practice.
  
• As assigned, provide other Clinical Counselor duties, including ongoing evaluation of client progress, treatment planning, case management, care coordination, crisis intervention, and de-escalation.
  
• Consult and coordinate with other professionals when indicated to support continuity and quality of care.
  
• Ensure all documentation regarding client care, treatment, authorizations, and incidents is completed timely and accurately.
  
• Adhere to all organizational and departmental policies and procedures, including compliance with behavioral, ethical, documentation, and client boundary expectations.
  
• Maintain client records according to the organization's policies and procedures and all applicable confidentiality requirements.
  
• Maintain organization, Ohio MHAS, and CARF required training.
  
• Maintain license or registration appropriate to the profession and job requirements, including required continuing education throughout employment.
  
• Maintain strict confidentiality at all times, including compliance with HIPAA, 42 CFR Part 2, and other applicable privacy requirements.
  
• Other duties as assigned. 

Knowledge of: Area resources that may aid clients in on-gong recovery, safety rules and procedures, the organization’s policies and procedures, and de-escalation techniques for individuals who may be frustrated or exalted. Working knowledge of different pathways to recovery and social systems.  

Abilities: Multitask and work independently with minimal supervision. Communicate information clearly and effectively. Recognize unusual or threatening conditions related to persons with disabilities. Standing, bending, stooping, sitting, walking, reaching above and below shoulder, repetitive use of hands to operate office equipment. Sit and/or stand for extended periods of time. 

Working Conditions:  Standard clinical office setting. May require weekend, evening, and holiday hours. May be exposed to clients who are potentially angry or violent. General exposure to standard office equipment (computers, monitors, copiers, et

Qualifications and Education Requirements   

• Experience in working with Microsoft Office products, including email.  

• Experience with using and navigating Electronic Health Records and other industry related types of applications.  

• CPR/First Aid Certification  

• Bachelor’s Degree  
• Minimum of Licensed Social Worker (LSW) or Licensed Professional Counselor (LPC) required.