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Category: Clerical
Facility: Horizons Mental Health Center
Department: PATIENT ACCOUNTS
Schedule: Full Time - more than 72 hrs a p.p.
Shift: Day Shift
Hours: M-F 8-4:30
Job Details:

POSITION DESCRIPTION

 

 

This document is neither an employment contract, nor an all-inclusive list of duties and responsibilities for this position.

 

POSITION TITLE:

Clerk II – Authorizations

DEVELOPED:

01/17/2014

POSITION CODE:

5760

REVIEWED:

____

DEPARTMENT:

Financial Control – Business Office

REVISED:

     

REPORTS TO:

Chief Financial Officer

CLASSIFIED:

Unknown

 

PRIMARY CUSTOMERS: (check all that apply)

 

 

DIMENSIONS:

 

Patients

 

Physicians

 

Supervision:

# of Direct Reports:

0

 

Families

 

Visitors

 

 

# of Indirect Reports:

0

 

 

Hutch Regional Team

 

Other:

 

Budget:

Operating $:

0

 

 

Affiliate team

 

 

 

 

Payroll $:

0

 

                               

GENERAL SUMMARY:

 

            Maintains accurate and detailed records regarding the status of all authorizations for service for Medicaid clients as required by each of the Managed Care Organizations (MCOs) for Kancare of Kansas.  Works closely with the Medicaid Biller and Care Coordinators to enhance billing accuracy and ensure that all medically necessary services are pre-authorized prior to the service being provided.

            Maintains appropriate relationships with personnel and public.  Responsible for self-development.

            Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. 

 

ESSENTIAL FUNCTIONS:

 

  • Produces the Authorizations Report in ClaimTrak on a bi-weekly basis ensuring that the parameters entered produce the desired data.  The purpose being to determine which clients are approaching the threshold whereby additional services may be required beyond those already approved and notify the appropriate internal staff responsible for seeking documentation establishing medical necessity from the client’s healthcare specialist.
  • Updates reporting parameters to correspond with changes in approved hours as determined by the Medicaid MCO’s of KanCare in total and in incremental numbers for each service and MCO.
  • Upon notice of change of authorized units by any MCO, updates all client authorizations within the Authorizations data base and expires all old authorized units.
  • Notifies the appropriate internal staff of those who are approaching or have exceeded the established internal threshold for renewal since the previous reporting period.
  • Maintains an electronic spreadsheet of Outpatient Treatment Requests (OTR’s) that have been sent to the Director of Access to Care for distribution among the Care Coordinators for completion in order to determine those that remain outstanding and require follow up..
  • Faxes completed OTR’s to the appropriate MCO for each Medicaid client.
  • Scans OTR’s into client chart within ClaimTrak
  • Updates the ClaimTrak Authorization Tab upon notification of approval by the MCO.
  • Other duties as determined by the Business Office Manager and the CFO to be necessary to maintain the business operations of Horizons MHC.

 

 

MINIMUM KNOWLEDGE AND SKILLS REQUIRED:

 

  • Excellent math and reasoning skills
  • General understanding of the personal computer and spreadsheet applications.  Can develop and maintain spreadsheets in an accurate manner that is well organized.
  • Can read and understand computer reports.
  • Demonstrated ability to read, understand and communicate oral and written instructions effectively.

 

 

PREFERRED KNOWLEDGE AND SKILLS:

 

·         Microsoft Office applications, or demonstrates the ability to learn the applications quickly and competently.

·              

·              

 

 

MINIMUM EDUCATION AND EXPERIENCE REQUIRED:

 

  • High School diploma or equivalent training and experience.
  • General office experience and computer training with three (3) years’ experience or special training in cash handling protocol and/or insurance billing experience with a private company or medical institution.

 

 

PREFERRED EDUCATION AND EXPERIENCE:

 

·         Associate degree, if possible.

·              

·              

 

 

LICENSURE OR REGISTRATION REQUIRED:

 

  •      
  •      
  •      

 

 

PREFERRED LICENSURE OR REGISTRATION:

 

·              

·              

·              


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Horizons Mental Health Center

 

PHYSICAL REQUIREMENTS

POSITION:   Clerk II – Authorizations & Remittances DATE                      REVISED:  January 17, 2014 

 

Employees in this position are required to meet the following physical requirements:

 

 

A = Rarely or Never

 

C = Some Times each Day

 

B = Not Every Day

 

D = All or Most of the Time

 

 

 

Physical Factors:

 

Physical Strengths:

 

   C

Standing/Stationary

 

Lifting – Push/Pull While Standing

 

   D

Standing/Moving About

  C

Up to 10 lbs.

   D

Sitting

  A

10 - 20 lbs.

   A

Climbing Stairs

  A

20 - 50 lbs.

   A

Balancing

  A

50 - 100 lbs

   C

Stooping/Bending

  A

100+ lbs

   A

Kneeling

 

 

   A

Crouching

 

 

   A

Crawling

 

 

 

 

 

 

Moving:

 

Carrying:

 

   C

Reaching

 

  C

Up to 10 lbs.

   D

Handling

 

  B

10 - 20 lbs.

   D

Fingering

 

  A

20 - 50 lbs.

   D

Talking

 

  A

50 - 100lbs.

   A

Driving

 

  A

100 + lbs.

   A

Smelling

 

 

 

 

Other:

 

 

 

 

 

 

 

 

Visual Demands:

 

Hazardous Conditions:

 

  D

Near Vision

 

   A

Respiratory Irritants: Dust, Fumes, Gases

   C

Far Vision

 

   A

Skin Irritants: Dust, Fumes, Gases

   A

Depth Perception

 

   A

Allergic Irritants:  Dust, Fumes, Gases

 

Accommodation

 

   A

Wet Work Hands

   A

Color Vision

 

   A



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