Quality Assurance Spec
Under general to limited supervision, the Quality Assurance Specialist will perform professional and administrative work coordinating and implementing a quality assurance program in a facility providing specialized or community-based services or assisting with the implementation of an intense quality assurance program of substantial scope and complexity for persons with mental illness and/or developmental disabilities.
Responsibilities
· Ensures accurate and timely processing of authorizations.
· Post incoming Carelon Files with Registrations, authorizations and discharges.
· Research and resolves rejections.
· Communicates correction instructions with staff, re-submits files when updated.
· Submits OTRs in GAMMIS and monitors for same day service needs.
· Checks portals for authorization updates.