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Authorization Specialist
Full job description
- Treat all individuals with dignity and respect while maintaining agency standards of confidentiality, professionalism and objectivity.
- Maintain/Assist all confidentiality requirements and regulations as outlined in CARF policies and procedures.
- Identify payor sources for patient services and assist with applications. (Department Cross Train)
- Monitor third-party payor pre-certifications and reviews and notify counselors when they need to be completed.
- Assist patients in obtaining county funding for services. (Department Cross Train)
- Track applications for authorizations. (Department Cross Train)
- Develop a thorough understanding of levels of care, services provided, criteria, and CPT codes to use in the process of receiving authorizations; complete initial authorizations, continued authorizations.
- Working with the billing department on appeals and denials.
- Build close working relationships with network providers.
- Assist medical and psychiatry prior authorizations.
- Coordinate with internal staff to collect necessary documentation and follow up requests in the authorization process.
- Complete initial and concurrent authorizations for the following level of care: Residential III.5, Day treatment II.5, and IOP II.1.
- Contact insurances for benefits information. (Department Cross Train)
- Obtain authorizations for services when insurances require authorizations.
- Comply with agency policies, procedures, and regulatory standards.
- All other duties as assigned.
QUALIFICATIONS/SKILLS/KNOWLEDGE REQUIRED FOR POSITION
- Minimum 2 years experience in a medical office setting.
- Preferred working knowledge of insurance companies.
- Supportive of the mission of Prairie Ridge and the patients we serve.
- Proficiency in oral and written communication skills, as well as documentation requirements.
- Technology skills allowing for proficiency in use of electronic health record.
- Travel may be expected.
- While performing the duties of the job, the employee is regularly required to sit; use hands to finger, handle, or feel objects, tools, or controls; and talk or hear. The employee frequently is required to walk and stoop, kneel, crouch, or crawl. The employee is often required to stand, reach with hands and arms, and climb or balance.
- The employee must infrequently lift and/or move up to 10 pounds and occasionally lift and/or more up to 35 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, and the ability to adjust focus.
