Administrative Specialist (Utilization Management)

OhioGuidestone provides a complete continuum of responsive person-centered prevention services mental health and substance use treatment and wrap-around supports serving the needs of over 50000 people each year through telehealth and locations across Ohio.

At OhioGuidestone we believe a workforcecomprisedof employees from diverse backgrounds andcommunitiesand a culture of belonging makes us a better organization. Together we continue to build a workplace that encourages supports and celebrates the varied voices of our employees.

Essential Functions:

• Demonstrate the values and guiding principles of OhioGuidestone every day performing with the highest standards of excellence integrity and ethics.
• Provide administrative and operational support to the Billing department.
• Receive review and route authorization and utilization management requests to the appropriate department or clinical reviewer.
• Verify member provider authorization and service information for completeness and accuracy.
• Enter and maintain authorization and related information in designated internal systems.
• Monitor requests and cases to ensure required information is obtained and established deadlines are met.
• Request missing documentation from provider offices health plan staff and/or internal departments.
• Communicate with providers members health plan staff and internal teams regarding administrative aspects of authorization requests.
• Track pending approved denied and incomplete requests and provide appropriate follow-up.
• Maintain accurate records and documentation in accordance with department procedures organizational policies and applicable regulatory requirements.
• Prepare reports spreadsheets and status updates related to Utilization Management activities.
• Identify administrative issues discrepancies missing information or delays and escalate concerns appropriately.
• Follow established workflows policies regulatory requirements and confidentiality standards.
• Assist clinical reviewers and department leadership with administrative tasks projects and other duties as assigned.
• Maintain productivity accuracy and quality standards established by the department.
• Exhibit positivity flexibility and a willingness to take on new responsibilities as requested or required.
• Demonstrate positive leadership promote a team-based work environment and a culture of belonging.
• Present the Agency in the most positive light with all internal and external contacts.

Education & Experience:

• High School Diploma or GED required.
• Associate or bachelors degree preferred.
• 13 years of experience in healthcare administration insurance medical office operations prior authorization claims utilization management or a related field preferred.
• Experience with electronic medical records health plan authorization or case-management systems preferred.

Qualifications:

• Mission driven; strong desire to make an impact
• Proficient with technology including dispatch systems electronic health records (EHRs) and Microsoft Office Suite.
• Ability to work both independently and collaboratively within a fast-paced environment.
• Effective interpersonal skills; able to speak effectively with individuals and/or groups of people
• Flexible; able to work days evenings and/or weekends as desired to meet the needs of clients

What we offer

• Stable non-profit organization with160 yeartrack record!
• Competitive medical benefitsincludingâa low-premium medical plan option foremployee or employee children!
• 10 paid holidays (some are exchangeable)
• Flexible work schedules to support work/life balance
• 401(k) with employer matchoption
• Employment Assistance Program (EAP)
• Recognition and rewards

Wealsocare about the health and safety of our employees. OhioGuidestone requires applicants to complete a pre-employment screening process upon receipt of an offer of employment. Werequireand cover the cost of fingerprint background screening physical Tuberculosis test and drug screen after an employment offer is made. Any employment offer is contingent upon receipt of all satisfactory pre-employment screenings.â

Required Experience:

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