Therapy and Beyond
Job Description
The
Authorization and Benefits Specialist
is responsible for the full lifecycle of insurance verification and authorization. This role ensures financial reimbursement by securing pre-authorizations, obtaining retroactive approvals, and maintaining active authorizations for ongoing care. The Specialist serves as a liaison between the organization, third-party payors, and clinical staff to prioritize efficiency.
JOB-SPECIFIC FUNCTIONS:
Authorization Management:
Initiate and secure initial benefits, pre-authorizations, and re-authorizations via payor portals, fax, or telephone.
Follow-Up & Tracking:
Strictly adhere to follow-up schedules (e.g., 3, 7, 14, 30 days) based on payor guidelines to expedite claims and prevent revenue loss.
Complex Case Resolution:
Manage high-complexity requests, including retroactive authorizations and Single Case Agreements (SCAs) for out-of-network patients.
Data Integrity:
Verify that authorization quantities, CPT codes, and effective dates are accurately entered into the practice management system.
Clinical Collaboration:
Coordinate directly with healthcare providers to secure necessary clinical notes, letters of medical necessity, and supporting documentation in a timely manner.
Process Improvement:
Develop and maintain a centralized "Payor Master List" and internal authorization manuals to standardize workflows and improve efficiency.
Compliance:
Review and interpret insurance group pre-certification requirements to ensure full compliance before services are rendered.
Qualifications
Education:
Associate’s or Bachelor's degree in Healthcare Administration or related field preferred.
Experience:
Minimum of 2 years of experience in insurance verification, medical billing, or authorization management.
Technical Skills:
Proficiency with electronic medical records (EMR) systems, and payor portals.
Soft Skills:
Strong written and verbal communication skills with the ability to build rapport with insurance representatives. Excellent organizational skills and attention to detail.
Additional Information
Generous benefit Package: Medical, Dental, Vision, and Disability
Company Paid- Life Insurance
401K with company match
Company Paid Short-Term Disability
HSA and FSA options
Employee Assistance Program
Employee Recognition
#J-18808-Ljbffr
Authorization and Benefits Specialist
is responsible for the full lifecycle of insurance verification and authorization. This role ensures financial reimbursement by securing pre-authorizations, obtaining retroactive approvals, and maintaining active authorizations for ongoing care. The Specialist serves as a liaison between the organization, third-party payors, and clinical staff to prioritize efficiency.
JOB-SPECIFIC FUNCTIONS:
Authorization Management:
Initiate and secure initial benefits, pre-authorizations, and re-authorizations via payor portals, fax, or telephone.
Follow-Up & Tracking:
Strictly adhere to follow-up schedules (e.g., 3, 7, 14, 30 days) based on payor guidelines to expedite claims and prevent revenue loss.
Complex Case Resolution:
Manage high-complexity requests, including retroactive authorizations and Single Case Agreements (SCAs) for out-of-network patients.
Data Integrity:
Verify that authorization quantities, CPT codes, and effective dates are accurately entered into the practice management system.
Clinical Collaboration:
Coordinate directly with healthcare providers to secure necessary clinical notes, letters of medical necessity, and supporting documentation in a timely manner.
Process Improvement:
Develop and maintain a centralized "Payor Master List" and internal authorization manuals to standardize workflows and improve efficiency.
Compliance:
Review and interpret insurance group pre-certification requirements to ensure full compliance before services are rendered.
Qualifications
Education:
Associate’s or Bachelor's degree in Healthcare Administration or related field preferred.
Experience:
Minimum of 2 years of experience in insurance verification, medical billing, or authorization management.
Technical Skills:
Proficiency with electronic medical records (EMR) systems, and payor portals.
Soft Skills:
Strong written and verbal communication skills with the ability to build rapport with insurance representatives. Excellent organizational skills and attention to detail.
Additional Information
Generous benefit Package: Medical, Dental, Vision, and Disability
Company Paid- Life Insurance
401K with company match
Company Paid Short-Term Disability
HSA and FSA options
Employee Assistance Program
Employee Recognition
#J-18808-Ljbffr