MLTC Authorization Specialist

Representative will be responsible for ensuring excellent and efficient customer service, ensuring that all covered services are authorized and placed in a timely manner, as well as provide support for all functions of the Extended MLTC as required.

• Utilizes excellent customer service skills to provide administrative support, information, education, and direction to all MLTC members.
• Able to educate members/providers regarding MLTC service authorization policies, and member rights and responsibilities.
• Responsible for generating and revising all service authorizations as per Nurse Care Manager instructions.
• Responsible for completing all authorization summary letters and ensuring receipt by providers.
• Responsible for mailing of all notices, letters, and other member/provider correspondence.
• Responsible for faxing, scanning, uploading, and maintaining all letters for authorized services.
• Able to address queries from enrollees or providers regarding the MLTC program and any of its policies and procedures.
• Able to direct calls to appropriate staff members and ensure that all measures are taken to assist members/providers.
• Communicates with Nurse Care Managers and Member Care Associates regarding member services, authorization requests and authorization issues.
• Works carefully out of an assignment queue, reviewing all authorization requests for accuracy and prioritizing based on urgency.
• Coordinates appropriate communication and documentation between members and providers.
• Coordinates with members/providers to ensure that appropriate services are placed in a timely fashion.
• Maintains assigned Nurse Care Manager spread-sheets to ensure timely renewal of expiring authorizations.
• Conducts thorough review of member’s current services to ensure accuracy of renewed authorizations.
• Responsible for documenting and reporting all communications with appropriate staff members (requests for services/assistance, communications regarding completed & sent authorizations, etc.)
• Performs other duties as assigned.
• Assisting in training new incoming staff members on departmental responsibilities as needed.
• Adheres to all applicable regulations, policies, and procedures of the MLTC plan.

• High School Diploma or GED required
• Previous experience with health plan operations preferred