• Job Description

  Req#: 25-78928
  
  Position Purpose:
  Supports the prior authorization request to ensure all authorization requests are addressed properly and in the contractual timeline. Aids utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
  
  Education/Experience:
  Requires a High School diploma or GED.
  Entry-level position typically requiring little or no previous experience.
  Understanding of medical terminology and insurance preferred.
  
  
  Supports authorization requests for services in accordance with the insurance prior authorization list
  
  Supports and performs data entry to maintain and update authorization requests into utilization management system
  
  Assists utilization management team with ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
  
  Contributes to the authorization review process by documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
  
  Remains up-to-date on healthcare, authorization processes, policies and procedures
  Performs other duties as assigned
  
  Complies with all policies and standards
  
  EEO:
  
  “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
  
  ======
  Story Behind the Need
  What is the purpose of this team? Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?	The purpose of these positions is to ensure timeliness of authorization builds to meet our contractual turnaround times and to ensure their understanding of contractual and operational impacts that this can cause if not met. The team is very structured and very communicative, especially regarding assignments. They are very aware of our strict turnaround times and communicate on if there are issues or possible problems in meeting this. No additional hiring needs currently.
  Typical Day in the Role
  Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?	Day to day responsibilities include answering intake calls from providers, processing authorizations that come in via Fax through our Filenet portal, which includes building of the authorization, tasking the authorization to the clinical team timely and making a note within TruCare to document their efforts. This is the number one priority of this position as well as answering inbound calls. Expectations include: meeting phone service levels at > 95% daily and completing 35 touches (authorization builds that are documented as complete in a note within TruCare) per day. We will discuss metrics regarding phone service levels in more detail once onboarding and the importance of utilizing aux codes appropriately and timely. Audit scores of > 95% each month. Provider facing About 35 auths a day May have to speak with provider offices Teams, word, excel, outlook, one drive, one note, (Avaya phone system, filenet auths, trucare )
  Candidate Requirements
  Education/Certification	Required: High school diploma or GED	Preferred: Either
  Licensure	Required: None	Preferred: Any license in healthcare administration or experience in managed care
  Years of experience required: At least 1-2 years of related experience (intake, insurance, prior auth, utilization management), experience within foster care. Disqualifiers: Only call center experience, longevity (please state if contract and if completed), if candidate is a foster care parent or came from foster care will need to go through further compliance within MO. Additional qualities to look for: Previous managed care experience, utilization/intake experience
  Top 3 must-have hard skills stack-ranked by importance	1	Organization and prioritization /
  2	Able to communicate verbally and written with providers and team /
  3	One who can work independently and can meet timely deadlines / independent work / multitasking skills
  
  

• About the company

  Mindlance is one of the largest diversity-owned staffing firms in the US . As a recruitment centric talent acquisition company, Mindlance provides Technology, Engineering, Digital / Creative / Marketing, Clinical Research, Scientific, Finance, Professional and Payroll Management staffing services to Global 1000 companies across the US, Canada and India.

Notice