Clinical Authorization Specialist - High Tech Radiology

We need to output HTML fragment with sections for headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. The posting includes description, essential job functions, organizational expectations, measured by, essential qualifications (education, credentials/licensure, minimum experience), position requirements (abilities & skills), minimum physical expectations, minimum environmental expectations, and some mission statement. No explicit Benefits, Pay, Schedule. So we should not include those sections. We need to decide which headings to use: About the role (maybe description), Responsibilities (essential job functions), Requirements (maybe essential qualifications?), Qualifications (maybe education/credentials?), Skills (position requirements). We need to avoid duplication. The instruction: "Use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." So we can choose appropriate headings based on content. We have: - Description: "POSITION DESCRIPTION: Responsible for reviewing, submitting, monitoring and responding to issues regarding medical necessity prior authorizations for high tech radiology services, procedures and/or DME for IHA patients in multiple offices. Reviews patient medical history to identify supporting documentation in the patient chart relevant to the service or procedure; contacts insurance companies and obtains authorization." That's basically the role summary. Could be About the role. - Essential Job Functions: list of duties. That's Responsibilities. - Organizational Expectations: could be part of Requirements? Might be considered Qualifications? But it's more about behavior expectations. Could be part of Requirements or Qualifications. However we have separate headings for Requirements and Qualifications. Usually Requirements = minimum qualifications (education, experience). Qualifications = preferred? But we can map: Essential Qualifications (education, credentials/licensure, minimum experience) -> Qualifications. Position Requirements (abilities & skills) -> Skills or Requirements? The instruction list includes Requirements and Skills separate. We could put Requirements for education/experience, and Skills for abilities & skills. Thus:

About the role

... description ...

Responsibilities

• ... each essential job function ...

Qualifications

• Education: Undergraduate degree or Associate’s degree in healthcare or graduate of an accredited LPN, PTA, Radiology Technician or Technologist, Respiratory Therapy, Ultrasound or Medical Assistant program.
• Credentials/Licensure: Valid, unrestricted LPN license in MI; PT A license; Respiratory Therapist license; Radiology Technician/Technologist Certification; Ultrasound Technician Certification; or Certification as a Medical Assistant via listed agencies.
• Minimum Experience: 1-3 years’ previous clinical experience; 3 to 5 years’ experience with insurance referrals, prior authorization or other relevant medical office experience.

Skills

• Proficient/knowledgeable in medical terminology.
• Proficient knowledge of major health plans and insurance processes.
• Knowledgeable in obtaining medical necessity authorizations for multiple offices.
• Strong knowledge in multiple imaging modalities.
• Strong knowledge in disease processes and the appropriate testing.
• Knowledgeable in ICD 10/CPT coding.
• Ability to perform mathematical calculations needed during the course of performing basic job duties.
• Proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, Microsoft 365 office suite (strong Excel work), email, e-learning, intranet and computer navigation.
• Ability to use other software as required while performing the essential functions of the job.
• Ability to perform data collection and data review assignments.
• Ability to track pending authorizations for multiple offices.
• Ability to document steps, processes and procedures.
• Excellent communication skills in both written and verbal forms, including communications with insurance companies and proper phone etiquette.
• Ability to read, understand and respond to detailed written and oral instructions.
• Ability to speak before groups of people, either in-person or virtually.
• Ability to communicate effectively with medical offices, physicians and both clinical and clerical staff.
• Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.
• Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, providers, patients, vendors, family members, outside customers and community groups.
• Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
• Good organizational and time management skills to effectively juggle multiple priorities, time constraints and ever-changing medical situations.
• Ability to exercise sound judgement and problem-solving skills.
• Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations.
• Ability to handle patient and organizational information in a confidential manner.
• Successful completion of IHA competency-based program within introductory and training period.

We might also include Organizational Expectations as part of Requirements? But we already have Requirements heading unused. Could put Organizational Expectations under Requirements. However the instruction says "Prefer a few substantive sections over many thin ones." We already have About the role, Responsibilities, Qualifications, Skills. That's four sections. Could add Requirements for Organizational Expectations and Minimum Physical/Environmental Expectations? Those are also substantive. But we could combine them into Requirements? However Requirements already used for education/experience; but we could rename? The headings are fixed examples but we can use them as we like. We could use Requirements for the organizational expectations, physical, environmental expectations. But then we would have duplicate content? Let's see. We have Organizational Expectations: a paragraph about positive work environment, mission, safety, training, confidentiality, role model, etc. That's substantive. Minimum Physical Expectations: details about keyboarding, lifting, vision, hearing. Minimum Environmental Expectations: typical office environment, interruptions, stress. These are also substantive. Could be placed under Requirements (maybe as "Requirements" heading). But we already used Qualifications for education/licensure/experience. Could we use Requirements for the physical/environmental/organizational expectations? That seems plausible. Thus we would have sections: About the role, Responsibilities, Qualifications, Skills, Requirements. But we need to avoid too many thin sections. Each of these has decent content. Let's craft:

About the role

POSITION DESCRIPTION: Responsible for reviewing, submitting, monitoring and responding to issues regarding medical necessity prior authorizations for high tech radiology services, procedures and/or DME for IHA patients in multiple offices. Reviews patient medical history to identify supporting documentation in the patient chart relevant to the service or procedure; contacts insurance companies and obtains authorization.

Responsibilities

... list each essential job function ...

Qualifications

... education, credentials/licensure, minimum experience ...

Skills

... abilities & skills ...

Requirements

... organizational expectations, physical expectations, environmental expectations ...

We need to ensure we don't include boilerplate like "Our Commitment Rooted in our Mission..." that's EEO? Actually that's mission statement but not EEO. It's about commitment. Might be considered organizational expectations? It's after "Our Commitment". Could include that as part of Requirements? It's about mission and values. Could be included. We must remove EEO/equal-opportunity/boilerplate, duplicated lines, and application instructions. The posting ends with "Our Commitment ..." and then "We are an Equal Opportunity Employer...". That's EEO boilerplate; we should remove that. Also remove the job ID line "00691365". Also remove "Employment Type: Full time Shift: Day Shift" maybe? That's metadata; we could fold into a short p or drop. The instruction: "do NOT put Job ID / requisition numbers as headings — fold minor metadata into a short

or drop it." So we could include a short p at top for Employment Type and Shift. But we already have About the role section; we could add a p before headings? The instruction says output only HTML fragment; we can include a p for metadata. However they said "fold minor metadata into a short

or drop it." So we can include a short p with that info. Let's do:

Employment Type: Full time | Shift: Day Shift

before sections. Now we need to list responsibilities items. Let's extract from Essential Job Functions: - Responsible for reviewing, submitting, monitoring and responding to issues regarding prior authorizations for high tech radiology services, procedures, and/or DME. - Professionally communicates (oral or written) with the ordering provider for next steps, practice support staff and representatives of insurance companies. - Reviews patient medical history, labs, pathology, imaging reports, ED records, consultations, etc. to identify supporting documentation in the patient chart relevant to the testing being ordered. - Performs data collection and data review assignments as required. - Contacts insurance companies or appropriate third party and obtains authorizations. - Updates information in patient medical record (EMR) with approval or denial information; follows up with ordering physician as to status and/or issues with prior authorizations. - Monitors in-basket, email and fax server if applicable. - Follows up on correspondence timely and accurately. - Obtains urgent authorizations same day, next day. - Verify correct procedural codes, diagnostic codes and insurance verification. - Monitors authorizations or denials and follows up, as necessary. - Contacts insurance companies or appropriate third party and obtains authorizations. (duplicate) - May act as a mentor to other team members. - May assist with ongoing training of new and existing staff. - Supports other offices, attends required meetings and trainings, and participates in committees as requested. - Performs other duties and participates in special projects, as assigned. We need to deduplicate duplicate line about contacting insurance companies (appears twice). We'll keep one. Now Qualifications items: Education: Undergraduate degree or Associate’s degree in healthcare or graduate of an accredited LPN, PTA, Radiology Technician or Technologist, Respiratory Therapy, Ultrasound or Medical Assistant program. Credentials/Licensure: Valid, unrestricted LPN license in the State of Michigan; Valid, unrestricted Physical Therapy Assistant license in the State of Michigan; Valid, unrestricted Respiratory Therapist license in the State of Michigan; Radiology Technician or Technologist Certification; Ultrasound Technician Certification; or Certification as a Medical Assistant through one of the following certifying agencies: American Association of Medical Assistants (CMA) American Medical Technologists (RMA) National Center for Competency Testing (NCMA) National Healthcareer Association (CCMA) National Association of Health Professionals (NRCMA) American Medical Certification Association (CMAC) Minimum Experience: 1-3 years’ previous clinical experience; 3 to 5 years’ experience with insurance referrals, prior authorization or other relevant medical office experience. Now Skills items from Position Requirements (ABILITIES & SKILLS): - Proficient/knowledgeable in medical terminology. - Proficient knowledge of major health plans and insurance processes. - Knowledgeable in obtaining medical necessity authorizations for multiple offices. - Strong knowledge in multiple imaging modalities. - Strong knowledge in disease processes and the appropriate testing. - Knowledgeable in ICD 10/CPT coding. - Ability to perform mathematical calculations needed during the course of performing basic job duties. - Proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, Microsoft 365 office suite (strong Excel work