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Service Authorization Specialist
Organization Overview
Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.
Position Summary
Commonwealth Care Alliance’s (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA’s benefits plan.
The Service Authorization Specialist is responsible for providing accurate, prompt, and appropriate entry of all medical referrals and requests from CCA Clinicians, Members, Vendors and Providers for services needing prior authorization.
The Service Authorization Specialist reports to the Service Authorization Intake Manager.
Key Responsibilities
  • Coordinates with the clinical teams to conduct non-clinical activities required for medical management (e.g, ensuring submissions for completeness and accuracy, data entering required information, submitting service requests for clinical review)
  • Assists with the accurate collection of necessary structured data for completion of service decision request
  • Provides clear and accurate documentation of all communication and activities
  • Handles all requests timely and accurately, adhering to performance measures
Education Requirements
  • Associate’s Degree or equivalent experience required
  • Bachelor's Degree preferred
Experience Requirements
  • Education, training or experience as a medical coder, medical billing, Insurance Coordinator or other relevant clinical background preferred
Knowledge, Skills and Abilities
  • Medical terminology knowledge necessary
  • Basic arithmetic skills required
  • Working knowledge of CPT and ICD coding
  • Demonstrated ability of critical thinking skills to efficiently organize work and maintain a high level of accuracy and productivity
  • Working knowledge and ability to navigate through the healthcare system (insurances, Medicare, Medicaid, physician office operations)
  • Ability to work independently with minimal supervision; as well as ability to work well in a team model to solve problems, improve workflow, and maintain cooperative working relationships with stakeholders
  • Proficiency in Microsoft Office Suite
  • Strong customer service and problem solving skills
  • Computer proficiency
Working Conditions
  • Office environment
Language Requirements
  • English required, bilingual preferred
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