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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in insurance verification processes, including authorization submission and clinical documentation management. Proficient in navigating electronic health records and payer web portals while maintaining compliance with Medicare/Medicaid regulations.
Highest-signal resume keywords
Insurance VerificationAuthorization SubmissionClinical Documentation ManagementMicrosoft Office ProficiencyKnowledge of Medicaid and CMO Guidelines
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance VerificationAuthorization SubmissionClinical DocumentationData EntryPayer Web PortalsDocumentation AccuracyUtilization ManagementAuthorization TrackingDetailed WritingPolicy Compliance
Soft Skills
Attention to DetailOrganizational SkillsDecision-Making AbilityCommunication SkillsSelf-Motivation
Tools & Technologies
GAMMISMyEvolvElectronic Health RecordsProvider ConnectCMO Websites
Industry Keywords
MedicareMedicaidDBHDD GuidelinesAuthorization ProcessesClinical Setting
Tech Stack
Tools & technologiesReact
About the role
Key responsibilities & impact- Perform insurance verification and verify insurance benefits
- Understand insurance authorization processes and required clinical documentation
- Navigate GAMMIS and complete insurance verification and activity status
- Complete MyEvolv data entry for authorization-status changes
- Follow up with clinical staff to obtain documentation and submit authorization requests
- Submit outpatient treatment requests through GAMMIS, Provider Connect, and CMO websites
- Interface with insurance companies regarding denials, pending authorizations, and partial approvals
- Update staff on authorization status and obtain needed documentation
- Use electronic health record sections, including the message board, to document authorization status and clinical-documentation needs
- Scan and upload authorization documentation into electronic health records
- Maintain weekly tracking of authorizations and documentation due
- Provide weekly summaries to RCM regarding outstanding OTRs, determinations, and unresolved workflow bottlenecks
- Serve as a resource regarding Medicare/Medicaid rules, DBHDD guidelines, and CMO authorization requirements
- Participate in other Utilization department tasks involving client charts
- Attend staff meetings and required trainings
- Provide documents to Human Resources and report status changes as required by policy
Requirements
What you’ll need- Preferred BA Degree and 2 years’ experience within the clinical, educational and/or hospital setting connected to an understanding of the documentation necessary for authorizations and billing
- Familiarity with searching payer web portals
- Working knowledge of insurance companies and authorization
- Great attention to detail, accuracy in documentation, organizational skills and ability to perform multiple tasks successfully
- Ability to learn and understand new programs quickly
- Ability to work independently as well as part of a team
- Solid decision-making ability for prioritizing authorizations and managing Utilization department tasks
- Ability to follow established policy and procedure in decision-making
- Ability to analyze and react to multiple situations
- Dependability, emotional stability and physical capability
- Ability to recognize when assistance and consultation is needed
- Strong communication and interactive skills
- Self-motivated and able to work under demand and deadlines
- Proficient in Microsoft Office (Word, Excel, Outlook)
- Knowledge of Authorization Submission with Medicaid and Care Management Organizations (CMOs)
- Proficiency with clinical documentation and detailed writing
- Must maintain confidentiality of consumer information, professional boundaries, mandated reporting requirements, and required certifications
Benefits
Comp & perks- Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions
- Required trainings and staff meetings
- Maintain any required certifications