Specialist, UM Administrative

Ohio Guidestone provides a complete continuum of responsive person-centered prevention services, mental health and substance use treatment, and wrap-around supports, serving the needs of over 50,000 people each year through telehealth and locations across Ohio.

At Ohio Guidestone, we believe a workforcecomprisedof employees from diverse backgrounds andcommunitiesand a culture of belonging makes us a better organization. Together, we continue to build a workplace that encourages, supports, and celebrates the varied voices of our employees.

Essential Functions:

• Demonstrate the values and guiding principles of Ohio Guidestone every day, performing with the highest standards of excellence, integrity and ethics.
• Provide administrative and operational support to the Billing department.
• Receive, review, and route authorization and utilization management requests to the appropriate department or clinical reviewer.
• Verify member, provider, authorization, and service information for completeness and accuracy.
• Enter and maintain authorization and related information in designated internal systems.
• Monitor requests and cases to ensure required information is obtained and established deadlines are met.
• Request missing documentation from provider offices, health plan staff, and/or internal departments.
• Communicate with providers, members, health plan staff, and internal teams regarding administrative aspects of authorization requests.
• Track pending, approved, denied, and incomplete requests and provide appropriate follow-up.
• Maintain accurate records and documentation in accordance with department procedures, organizational policies, and applicable regulatory requirements.
• Prepare reports, spreadsheets, and status updates related to Utilization Management activities.
• Identify administrative issues, discrepancies, missing information, or delays and escalat e concerns appropriately.
• Follow established workflows, policies, regulatory requirements, and confidentiality standards.
• Assist clinical reviewers and department leadership with administrative tasks, projects, and other duties as assigned.
• Maintain productivity, accuracy, and quality standards established by the department.
• Exhibit positivity, flexibility and a willingness to take on new responsibilities as requested or required.
• Demonstrate positive leadership, promote a team-based work environment and a culture of belonging.
• Present the Agency in the most positive light with all internal and external contacts.

Education & Experience:

• High School Diploma or GED required.
• Associate or bachelor's degree preferred.
• 1–3 years of experience in healthcare administration, insurance, medical office operations, prior authorization, claims, utilization management, or a related field preferred.
• Experience with electronic medical records, health plan, authorization, or case-management systems preferred.

Qualifications:

• Mission driven; strong desire to make an impact
• Proficient with technology, including dispatch systems, electronic health records (EHRs), and Microsoft Office Suite.
• Ability to work both independently and collaboratively within a fast-paced environment.
• Effective interpersonal skills; able to speak effectively with individuals and/or groups of people
• Flexible; able to work days, evenings, and/or weekends, as desired to meet the needs of clients

What we offer

• Stable non-profit organization with
  160+ yeartrack record!
• Competitive medical benefitsincludinga low-premium medical plan option for employee or employee+ children!
• 10 paid holidays (some are exchangeable)
• Flexible work schedules to support work/life balance
• 401(k) with employer match option
• Employment Assistance Program (EAP)
• Recognition and rewards

Wealsocare about the health and safety of our employees. Ohio Guidestone requires applicants to complete a pre-employment screening process upon receipt of an offer of employment. Werequireand cover the cost of fingerprint background screening, physical, Tuberculosis test, and drug screen after an employment offer is made. Any employment offer is contingent upon receipt of all satisfactory pre-employment screenings.