Medical Authorization Analyst II

Recruitment #220701-UNCE-392

Introduction

Medical Authorization Analyst II

Position Description:
Under direction, acts as medical eligibility and medical analyst.  Duties require independent judgment and coordination of diverse duties that require specialized knowledge as they relate to the authorization process for medical services that require prior authorization, including interpretation of state, agency or departmental policies, procedures, regulations and laws. The primary emphasis is complex analysis of compensable medical benefits that require prior authorization, requiring knowledge of specific or specialized subject matter(s), including ICD-10, CPT and HCPCS coding.

PRINCIPLE ACTIVITIES: 
- Independently determine compensability for requested medical services received for Medicaid eligible recipients: includes review of doctor’s statements, medical records and Agency forms to ensure eligibility standards are met.
- Work with Agency physicians, medical consultants, Medical Authorization and Review (MAR) nurses, MAR supervisors and MAR Medical Authorization Analyst III to evaluate recipient’s medical condition for medical appropriateness of services requested according to OHCA Medicaid policy, state and federal guidelines.
- Act as a consultant on OK Medicaid policies to Agency staff, as well as to other state agencies, for authorization of complex medical services.
- Work with contracted medical consultants to determine medical necessity and compensability for specialized medical services.
- Respond to telephone or email inquiries regarding policy, medical authorization protocol and submitted authorization requests from providers, recipients, legislators, Agency staff and other person(s) appropriate for this information.
- Performs MAR, OHCA and multi-agency special projects as required.
- Other duties as assigned.

TRAVEL:
No travel

SUPERVISORY RESPONSIBILITIES:
These positions have no supervisory responsibilities. They require day-to-day coordination of workflow within MAR, as well as with other Agency departments and, on occasion, other state agencies.  They require a high level of interpersonal skills, tact and discretion.

LEVEL DESCRIPTORS:
The Medical Authorization job family consists of three levels which are distinguished by the depth and breadth of accountability, the experience required to perform assigned duties and the responsibility for the leadership of others.
LEVEL II INCUMBENT:
- Responds to provider or agency staff inquiries including via email or telephone
- Must have experience in evaluating medical conditions for appropriateness of services according to OHCA’s policies/criteria
- Prepares cases for review by physicians, consultants and nurses in the areas of medical services, physical, occupational and speech (PT/OT/SP) therapy, durable medical equipment (DME), and private duty nursing
- Prior authorizes medical, DME or PT/OT/SP therapy requests at a level appropriate for the position
- Processes amendment requests for changes to prior authorizations
- Experience in using PA Workflow and iCE

KNOWLEDGE, SKILLS AND ABILITIES:
Knowledge of federal and state laws and regulations pertaining to medical service eligibility; of state and local health care assistance resources; and of medical terminology, human physiology and pathology.  Skill in accurately interpreting and applying policy and procedure on medical eligibility; in recognizing physical, mental and emotional conditions from written information; and in explaining eligibility determinations, both orally and in writing. 

The Oklahoma Health Care Authority complies with applicable Federal civil rights laws and does not discriminate.  All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.

Notice to applicants:
Please add personnel@okhca.org to the address book or “safe-senders” list in your email.  All correspondence will come from this address.  Be sure to check your junk folder.  If you have questions about the status of your application, you can contact the HR team at 405-522-7093.

MINIMUM QUALIFICATIONS

KNOWLEDGE AND BACKGROUND REQUIREMENTS
QUALIFICATIONS: To perform this job successfully, the individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skills, and/ or ability required. 

MEDICAL AUTHORIZATION ANALYST II EDUCATION AND EXPERIENCE:
- Associate’s degree AND
- 18 months of experience in the prior authorization process  OR
- An equivalent combination of education and/or experience totaling 3 ½ years

PREFERENCE MAY BE GIVEN TO CANDIDATES WITH:
- Experience using PA Workflow and iCE/MMIS
- Experience preparing cases for review in the areas of Physical, Occupational and Speech Therapy, Durable Medical Equipment, Private Duty Nursing and Medical Services
- Healthcare degree
- Medical business experience
- Medical insurance or coding experience
- Medicaid or SoonerCare experience

NOTES

Please read instructions carefully and include all required documents when you submit your application.

No additional information will be accepted after the application has been submitted.