Services Authorization Specialist

Essential Duties:

Generate Payment Authorization for Waiver Services (PAWS) and Payment Authorization for Services (PAS) of locally funded services for the Individual Service Plans (ISP) and ISP revisions consistent with ISP, assigned Ohio Developmental Disability Profile (ODDP) and Acuity Assessment Instrument (AAI). Submit to DoDD or MEORC and ensure PAWS/PAS confirmations are communicated as necessary.
Monitor the completion, revision and submission of the Acuity Assessment Instrument (AAI) & Ohio Developmental Disability Profile (ODDP) so that rates for waiver funded adult services are established and correct.
Conduct provider utilization reviews to assure compliance with ISP and PAWS/PAS for waiver and non-waiver funded services. Work with providers to resolve billing and payment issues.
Generate cost of Medicaid Waivers services, Supported Living, and locally funded services through the use of the cost projection tools.
Monitor patient liability.
Provide input into prior authorization as needed to determine approval or disapproval of all prior authorizations for waiver services that exceed the individual’s established range.
Maintain on-going communication and technical support with Service Coordinators and services providers on all fiscal aspects of the PAWS/PAS/ISP process.
Compile and run reports from the DoDD Data Warehouse.
As required, enter into the Imagine Information System service costing.
Driving is an essential function of the position.

Minimum Qualifications:

Associate’s degree
Excellent verbal and written communication skills for effective interaction with internal and external customers
Proven proficiency in Microsoft Office Products
Excellent organizational and time management skills
Superior customer service skills
Ability to obtain and maintain Service and Support certification per OAC 5123:2-5-02
Valid Ohio driver’s license with an acceptable driver’s abstract in order to meet criteria for insurability established by the Board’s fleet insurance carrier

Skilled in:

Human relations and establishing positive rapport with service providers and staff
Data entry and control
Use of Imagine Information System
Proficiency in use of Gatekeeper software, preferred

Knowledge of:

Agency, state and federal statutes, rules policies, regulations and/or procedures governing contracts for procurement of services and programs
Business management practices including, but not limited to: accounting, budgeting, contracting, interpreting financial reports, marketing, planning and scheduling
Local community resources and human services organizations
Local providers, preferred.

Interviews will be scheduled only for those candidates who best meet the above requirements.

POST DATE: 11-22-16 REMOVAL DATE: 12-6-16