Company Overview:
Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.
Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.
Job Summary and Responsibilities:

JOB SUMMARY:

• The purpose of this position is to utilize clinical expertise, critical thinking and decision-making skills to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness of Autism Spectrum Disorder Services, while maintaining production goals and QA standards.

REQUIRED QUALIFICATIONS/EXPERIENCE:

• Board Certified Behavior Analyst (BCBA) certification per contract requirements.
• Master’s degree from an APBA accredited program or an ABAI-accredited or recognized behavior analysis Master’s degree program (ABAI Tier 1, 2a, or 2b).
• 3+ years of recent clinical experience in the behavior analysis field.
• Strong clinical assessment and critical thinking skills.
• Medical record abstracting skills.

PREFERRED QUALIFICATIONS/EXPERIENCE:

• Experience with State Medicaid program(s).
• 1+ years Utilization Management/Utilization Review/Prior Authorization.
• Ability to work independently in a remote position with ability to adjust to demanding workload.
• Strong organizational skills.
• Requires excellent written and verbal communication skills.
• Must be proficient with computers and MS Office products, including Microsoft Teams.
  

  LI-SD1

“BASED ON OUR COMPENSATION PHILOSOPHY, AN APPLICANT’S POSITION PLACEMENT IN THE PAY RANGE WILL DEPEND ON VARIOUS CONSIDERATIONS, SUCH AS YEARS OF APPLICABLE EXPERIENCE AND SKILL LEVEL.”

Pay Range: USD $58,000.00 - USD $72,500.00 /Yr

• Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the medical record documentation supports the need for service.
• Determines approval or initiates doctoral level consultant; processes consultant decision ensuring any denial reason is described in sufficient detail on outgoing correspondence.
• Performs ongoing assessment of review process to offer opportunities for improvement and/or change.
• Assures accuracy and timeliness of all applicable cases within contract requirements.
• Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
• Fosters positive and professional relationships with internal and external customers.
• Responsible for attending training and scheduled meetings and for maintenance and use of current/updated clinical practice or policy information for appropriate case reviews.
• Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following Acentra Health’s policies, procedures and guidelines.
• Actively cross trains to perform duties of other contracts to provide a flexible workforce to meet client/customer needs.
• Always maintains medical record confidentiality through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
  This list is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.