Address
Form of workDescription
Summary/Objectives
The Prior Authorization (PA) department is responsible for the submission, tracking, extension and receiving of the Personal Care Attendant (PCA) evaluations (Prior Authorization) with Mass Health (MH). Prior Authorization (PA) Liaison perform their jobs accordingly to Mass Health PCA Operating Standards.
Core hours are Monday - Friday 8:30am to 4:30pm
Essential Functions
- Review and submit all evaluations to MH by following PCA Operating Procedures
- Notify consumer/surrogate and Skills Trainer of MH decision
- Track all consumers by PA expiration and discuss extension with supervisor
- Follow-up on all supporting documentations, MD, and consumer/surrogate/LG's signature as needed
- Quality Assurance (QA) Registered Nurse (RN) evaluations before submitting to MH
- Maintains confidentiality of all Consumer/PCA information
- Train/assist in training new department employees
- Monitor Senior Care Options (SCO)/One Care/Community Case Manager (CCM) inboxes and retrieve authorizations from faxes daily
- Enter PA information into database for all new SCO referrals, re-referrals and transfers when notified by intake that file is complete
- Review monthly EVs report from Fiscal Intermediary and update database as needed with changes in insurance/ programs. Send for authorizations when enrolled in One Care
- Must report all suspected incidents of consumer sexual/physical abuse and neglect to the Disabled Person Protection Commission (DPPC)
- Assist other departments as needed
- Other duties as assigned by Supervisor
Requirements
Competencies
- Strong Knowledge of Microsoft Office: Outlook, Excel and Word
- Creative problem solver
- Excellent telephone manner and organizational skills
- Excellent organizational skills for initiation and maintenance of efficient workflow
- Attention to detail
- Familiar with database operations
- Must display teamwork and commitment while performing daily duties
- Must demonstrate initiative and discipline in time management and assigned completion
- Regular and reliable attendance and time reporting
- Able to operate a computer keyboard, mouse, and other office type implements to accomplish document imaging duties
- Ability to work in a high production environment while maintaining close attention to detail
- Ability to work independently
- Must have experience working in an office environment
Required Education
- High School Diploma or equivalent education, some college preferred
Work Environment
- This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical Demands
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- This job requires at various times, the following physical activities: sitting, reaching, carrying, walking, pushing, pulling and lifting, finger dexterity.
Travel
- No travel is required for this position.
Work Authorization/Security Clearance
All offers of employment made by Tempus Unlimited are contingent upon satisfactory background check results. Pre-employment background checks will be conducted on all candidates that are offered a position at the agency in compliance with program policy as well as state and federal regulations. From time to time, these checks may be conducted on current employees to ensure compliance with all state and federal regulations and contracts.
EEO Statement
Equal Employment Opportunity is a fundamental principle at Tempus Unlimited, Inc. where employment from recruiting through the end of employment is based upon professional capabilities and qualifications without discrimination because of race, color, religion, sex, age, sexual orientation, veteran status, national origin, disability or any other characteristic as established by law.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.
Other Duties
Note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
