Auditor, Behavioral Health

Phoenix AZ 85034

Job Description

Facilitates department workflow by supporting clinical team with various care coordination workflows. Assists with reviewing, processing, and coordinating completed denial letters for multiple health plans.
  • Provides a review of a completed denial letter to ensure accuracy, template use and within the appropriate grade level.
  • Troubleshoots issues noted on letters by coordinating with team members and doctors to ensure clear and accurate letters. Completes data validation for data entry on letters (address, dates, and other fields as applicable).
  • Completes audits for end-to-end process including but not limited to UM BH Support & UM BH Appeals.
  • Assumes responsibility for self-development and career progression and proactively seeks and participates in ongoing training (formal and informal) in all aspects of the Care Worker role.
  • Assists in the training of new Care Workers, and provides data as needed to the Senior Manager of Operations.
  • Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
  • Coordinates and manages distribution of correspondence and materials to enrollees and providers.
  • Participates in operational activities, including data collection, tracking, and analysis.

General Job Information

Title

Auditor, Behavioral Health

Grade

18

Job Family

Operations Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

5/17/2019

Date Requisition Created

5/15/2019

Minimum Qualifications

Education

Associates

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Experience in a managed care environment, integrated medical and behavioral health care and/or training in chronic pain management.
  • Understanding of plan benefit structures, psychiatric/medical terminology, and local communication resources.
  • For roles supporting the Chronic Pain Management SBU, understanding of Chronic Pain Management guidelines and workflows is also required.
  • Less than 2 years experience in behavioral health

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.