Reauthorization Specialist Jobs (NOW HIRING)

The Intake Specialist manages the referral systems for Vinfen's Integrated Care Division Care Coordination programs in the Northeast region, including the Community Support Program (CSP) One Care, and Behavioral Health Community Partners (BHCP).

Vinfen's Care Coordination programs provide health care coordination services to MassHealth members with complex medical and behavioral health needs. The Intake Specialist markets Care Coordination programs to external parties such as Accountable Care Organizations (ACO), hospital systems, home health agencies and primary care practices to expand referrals. Once a referral is received, the Intake Specialist coordinates with internal existing Vinfen programs to increase enrollment including Adult Community Clinical Services, Behavioral Health Clinics, clubhouses, and other specialty programs.

The essential job duties/responsibilities of the position include but are not limited to the information listed below:

• Collaborates with referral sources to determine which care coordination program best fits a referred member based on current clinical and health care needs and insurance eligibility.
• Markets programs to external and internal parties to expand referrals as directed by supervisor.
• Checks referred members' insurance eligibility status in EOHHS Virtual Gateway platform at time of intake and reauthorization or at times of loss to determine necessary action steps to retrieve insurance.
• Manages all incoming referrals for CSP including taking referrals via phone or CSP email and complete Referral Form.
• Completes Massachusetts Behavioral Health Partnership (MBHP) authorization process for qualifying CSP referrals via the Interactive Voice Registration system or with the Authorizing Representative and ensure authorization is recorded in the Provider Connect System.
• Completes Beacon authorization process via eService's system for qualifying CSP referrals.
• Completes authorizations for other funding sources as required, including Optum and Tufts.
• Conducts audits in eHana to identify expiring CSP Authorizations and complete all reauthorizations for an additional 90 days of service as assigned.
• Creates new CSP member records in eHana after referrals are approved by supervisor.
• Assists in completing One Care referrals either directly with members via phone with Mass Health or with referral sources.
• Assists in completing BHCP referrals with Mass Health or ACO/MCOs and troubleshoot referral problems.
• Assists members to regain Mass Health when lost during service provision.
• Coordinates with internal programs to increase enrollment in Care Coordination entities (ACCS, Behavioral Health Clinics, clubhouses, other specialty programs).
• Completes enrollment documentation with CSP members when assigned by supervisor to include entering data in eHana for the MSDP Personal Information Form, providing orientation of services and after- hours information to the member and obtaining member signatures for Consent for Program Participation, Two-way Authorizations, Notice of Privacy Practices, and Grievance Procedures.
• Coordinates with Revenue Department and Director to fix identified problems with billing.
• Maintains updated roster of active CSP members and create Intake tracking reports.
• Manages process of obtaining and distributing acute care utilization information via daily review of Collective Medical Pre-Manage ED platform and coordination with involved acute care providers.
• Completes record reviews in eHana and other quality functions as needed for BHCP and One Care teams.
• Participates in regular team meetings.
• Seeks to maintain a constructive work environment and maintain effective communication with others.
• Maintains appropriate written and oral communication.
• Maintains confidentiality of member and employee information.
• Performs other related duties, as assigned.

Knowledge and Skills:

• Excellent organizational, time management, and problem-solving skills
• Ability to function effectively as part of a multi-disciplinary team
• Knowledge of personal computer applications and equipment: Word, Excel, PowerPoint, Outlook
• Knowledge of record keeping systems
• Knowledge regarding psychiatric rehabilitation and recovery
• Effective oral and written skills
• Strong interpersonal and customer relations skills
• Knowledge of business etiquette and practices
• Ability to communicate in a positive, courteous, and professional manner
• Ability to exercise judgment and discretion when handling complex and confidential matters

Established in 1977, Vinfen is a nonprofit, health and human services organization and a leading provider of community-based services to individuals with mental health conditions, intellectual and developmental disabilities, brain injuries, and behavioral health challenges. Our services and advocacy promote the recovery, resiliency, habilitation, and self-determination of the people we serve. Vinfen's 3,500 dedicated employees are experienced, highly-trained professionals who provide a full range of supportive living, health, educational, and clinical services in over 550 sites throughout Massachusetts and Connecticut. For more information about Vinfen, please visit www.vinfen.org/careers.

My Job. My Community. My Vinfen.

Vinfen is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.

Typical Requirements: Minimum of two years of experience working in Human Services or healthcare industry and strong administrative and organizational skills are required.

Preferred /Required Education: A high school diploma or equivalent is required. A Bachelor's degree is preferred. In some cases, experience may be substituted for academic training.

Physical Effort: Ability to lift at least 25 pounds using proper lifting techniques. Ability to operate a computer and other office equipment such as a calculator, copier, and printer. Ability to remain in a stationary position 50% of the time as needed. Ability to bend, reach, file, sit, stand and move around the facility. Ability to speak, hear and communicate with clients, staff and external representatives. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Required Certifications: CPR required within two weeks of hire. First Aid required within two weeks of hire.

USD $56,375.00 - USD $56,375.00 /Yr.