About this role
Role Overview
- Serves as a Prior Approval Specialist and conducts professional work in the interpretation of Department policies, procedures, instructions, and other related aspects regarding the Prior Approval process for durable medical equipment and specialized medical services
- Responds to telephone and/or written correspondence to/from medical vendors, agency staff, and the general public regarding inquiries, complaints, and requests for information and assistance
- Researches and analyzes prior approval requests submitted by medical providers to determine action for entering prior approvals
- Stays up to date on policy and procedure changes
- Attends meetings
- Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.
Requirements
- Requires knowledge, skill, and mental development equivalent to completion of four (4) years of college with courses in medical social work
- Requires two (2) years professional experience in fields related to medical social work
- Preferred: Licensure in one of the following specialties: Registered Nurse, Speech-Language Pathologist, Respiratory Therapist, Physical Therapist, or Occupational Therapist
- Preferred: Three (3) years of experience working with medical terminology
- Preferred: One (1) year of experience working with federal, state and local legislation and agency requirements pertinent to public assistance, medical care and rehabilitation assistance
- Preferred: One (1) year of experience providing consultation and instruction related to professional and medical social casework
- Preferred: One (1) year of experience providing customer service to medical provider offices on behalf of a payer
- Preferred: One (1) year of experience addressing policies and procedural inquiries from providers, interest groups and the general public.
Benefits
- Health, Life, Vision, and Dental Insurance
- Pension Plan
- Paid Parental Leave
- Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
- Paid Sick Days annually
- Paid Vacation Days their first year of service
- Paid Personal Days annually
- Paid holidays annually