Health Plan Analyst: Authorizations
- Corporate - Corporate Finance/Accounting
- Full Time
HEALTH PLAN ANALYST: AUTHORIZATIONS
PIEDMONT HEALTH SERVICES
The Health Plan Analyst; Authorizations is responsible for actively managing contract service authorizations for multi-site PACE division in collaboration with third party administrator. Develop working relationships with all contracted vendors and provides customer service in resolving service-related issues. Provides support to PHSC Finance functions as needed.
Education/Experience: Bachelor's Degree or 3 years of relevant experience. Experience working in healthcare/managed environment. Experience working with Medicare/Medicaid reimbursement of claims as it relates to authorization and adjudication of billable services is preferred.
• Excellent interpersonal, written and verbal communication skills
• Ability to explain and assist with complicated and detailed financial situations involving entitlement and public assistance programs
• Excellent time management skills
• Ability to work independently and multi-task
• Demonstrate good judgment, resourcefulness, flexibility and problem solving
• Possess sensitivity and awareness of diverse cultural perspectives and the ability to work with diverse populations
• Proficient with MS Word and Excel preferred
• Bilingual Spanish/English skills are helpful but not required
Type of Employees Supervised: None.
Licensure, Registry or Certification Required: none
Immunizations: Be medically cleared for communicable diseases and have all immunizations up-to-date prior to beginning employment.
PATIENT POPULATION SERVED
WORKING CONDITIONS/PHYSICAL DEMANDS
Hearing: Adequate to perform job duties in person and over the telephone.
Speaking: Must be able to communicate clearly to medical providers, patients and multiple personnel in person and over the telephone.
Vision: Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens. Must meet certification by colorblind standards.
Other: Will be working with potentially hazardous chemicals, exposure to patient body fluids.
Requires frequent lifting and carrying items weighing up to 40 pounds unassisted.
Requires frequent bending, reaching, and repetitive hand movements, standing, walking, squatting and sitting, with some heavy lifting, pushing and pulling exerted regularly throughout a regular work shift. Requires exposure to communicable diseases and/or bodily fluids.