Authorization/Compliance Manager

Description

DUTIES AND RESPONSIBILITIES:

Manages the operation of departmental

Act as the public speaker and public relations representative of the company in ways that strengthen its profile

Ensure adherence of the organization's daily activities and long-term plans to established policies and legal guidelines

Management of our Risk Management

Assess service capacity and staffing needs; ensures adequate staffing patterns.

Approves all personnel decisions, including position appointments, terminations, and disciplinary actions.

Oversite of all department compliance

Answer, screen, and transfer inbound calls from Managed Care Organizations (MCO)

Communicates with Quality Assurance to obtain documents from filing system and file room

Communicates authorization information to staff as updates are received

Communicates insurance discrepancies with staff as needed

Work with staff to investigate and determine the authorization status

Review forms for accuracy and completeness before faxing to MCO

Identifies and documents trends/problems with approvals and denials with authorizations

Modify and update tracking systems daily with the current status

Enters and transfers authorizations data in a timely and accurate manner into Electronic Health System

Assist with the appeals process when necessary

Any other assigned duties or responsibilities

Requirements

MINIMUM QUALIFICATIONS:

A Bachelor's degree in Social Work, Psychology, Human Services, or a related field from an accredited college or university;