Under the Quality Assurance (QA) Department, the Utilization Coordinator reviews client records to evaluate the documentation justifying service necessity and to ensure compliance with federal and state guidelines, accreditation standards and View Point Health (VPH) policy. The Utilization Coordinator provides scheduled trainings on documentation, service coordination standards and introduction to EHR system for new employee orientation and specific trainings as assigned and/or provides training support. The Utilization Coordinator performs review of authorization requests submitted by VPH staff and monitors for errors, as assigned. The Utilization Coordinator assists with input of data and generates reports to document errors and trends. The Utilization Coordinator provides clinical, administrative, and technical support to VPH staff as needed.

Duties & Responsibilities:

• Performs daily tasks with minimal supervision.
• Serves as clinical support in Behavioral Health/Addictive Disease & Intellectual Developmental Disability Practices to ensure compliance with regulations, standards and policies.
• Serves as lead or support trainer for paraprofessional and clerical trainings for designated days of new employee orientation.
• Provides support, feedback, training, and monitoring related to the completion, correction, submission and appeals of clinical/programmatic requests for service authorizations.
• Manages assigned QA tickets and participates in QA Support activities, as assigned.
• Conducts internal audits to include Peer and Quality Reviews to ensure Programmatic Integrity based on ERO and agency standards.
• Assists with external ERO audits and reviews, as assigned.
• Prepares reports to track authorizations, failed claims/activities, and to perform additional EHR monitoring, as assigned.
• Identifies trends, training needs, and areas for improvement and collaborates with QA UM Team Lead to develop new trainings for various types of staff and VPH programs.
• Collaborates with QA and VPH programs in the development and monitoring of corrective action plans, as assigned.
• Provides support for all other QA related trainings including management of certification renewals.
• Provides follow up support for VPH employees to assess training needs and coordinate with Program Manager/Directors to facilitate additional support/training.
• Attends agency and statewide meetings as determined by supervisor.
• Conducts trainings and/or provides training support for EHR and documentation trainings, as assigned. Monitors QA support requests for trends in CareLogic errors and collaborates with QA UM Team Lead and/or Director and EHR System Administrator to develop trainings, materials, and workflows for staff. Reviews clinical documentation (e.g. assessments, progress notes, treatment plans) for required ERO and agency standards and communicates with supervisors and staff to identify improvement needs.
• Reviews authorization submissions and EHR reports to identify trends and troubleshoot errors.
• Monitors unresolved errors and notifies clinical and billing staff immediately of corrections needed. Reviews ERO standards and programmatic requirements (e.g., admission criteria, clinical exclusions, billing and documentation requirements) to ensure compliance, corrections and training needs are met.
• Produces and reviews written reports with QA UM Team Lead and/or Director, and Program Directors to review identified needs and/or recommendations for program improvements.
• Performs internal audits, including quarterly peer reviews, monthly quality reviews, using established criteria to determine specific and overall issues related to compliance and/or training needs.
• Shares information with responsible clinician/supervisor and assists in formulating plans for correction/training. Assists staff 1:1 as needed to correct isolated problems.
• Maintains a good working relationship with physicians/clinicians/admin support/business office and others to keep them informed about rules and regulations.
• Acknowledges and responds to requests for information or support in a timely manner.
• Attends regular agency and program staff meetings to disseminate information and provides support.
• Knowledgeable in documentation and service coordination standards.
• Other duties as assigned.

Minimum Qualifications:

High School Diploma or GED with three (3) year experience in a technical job related to the area of assignment. May require a valid driver's license.

Preferred Qualifications:

In additional to the minimum qualification:

• Bachelor's Degree in counseling, social work, psychology, sociology or closely related field AND 2 years of professional experience in a Behavioral Health/Addictive Disease/Intellectual Developmental Disabilities setting.
• Knowledge of DBHDD provider manual and guidelines.
• Proficient use of CareLogic or other Electronic Health Record systems.
• Proficient understanding of authorization processes.
• Proficient use of Microsoft applications (Excel, Power Point).
• Ability to multi-task and initiative to problem solve.
• Ability to work well in a team environment and independently.
• Experience working with Microsoft Excel Spreadsheets
• Excellent communication, time management, and attendance skills

Requirements/Competencies:

• Must be able to lift 20 pounds.
• Requires long periods of sitting/standing.
• Must have valid Georgia driver’s license and Motor Vehicle Record in accordance with company policy.
• Candidates for selection must pass a criminal background check (including fingerprinting).
• Must pass a pre-employment drug screen and subject to random drug screens.
• Any combination of training and experience, which would have enabled the applicant to acquire the necessary knowledge, skills and abilities Note: Some positions may require a valid driver's license.
• Other duties as assigned.

Benefits (for qualified employees):

• State Health Benefits Package (medical, dental, vision, life insurance, disability, long-term care, legal services, flexible spending accounts)
• Paid New Hire Training
• Company contributes additional 7.5% of salary to 401(a) Retirement Plan
• No employee deduction for Social Security
• Additional benefits such as legal services, Employee Assistance Program and discounted tickets to attractions, shopping, technology and travel
• Supervision, training, and continuing education opportunities available

View Point Health is an Equal Opportunity Employer: View Point Health recruits qualified candidates for positions in View Point Health programs throughout its service area. It is the policy of View Point Health to provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination or harassment of any type without regard to race, color, sex, religion, national origin, age, disability, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Your resume must clearly demonstrate how you meet the Minimum and any Preferred Qualifications. This position is unclassified, and employment is at-will.

This position is subject to close at any time once a satisfactory applicant pool has been identified