Authorization Specialist

7 days ago

Las Cruces, United States MECA Therapies LLC Full time
Job DescriptionJob DescriptionSalary:

Position

Description:


As an Authorization Specialist within our Autism Program, you will play a vital role in ensuring that our clients receive the necessary care, through ensuring efficient authorization management and delivering exceptional customer service to our clients and their families. You will be responsible for:


● Customer-Centric Authorization Management:

○ Working closely with BCBAs and families to ensure timely submission of accurate and complete documentation for initial and re-authorizations.

○ Communicating effectively with insurance companies to negotiate approvals and resolve issues on behalf of clients.

○ Proactively advocating for clients' needs and ensuring equitable access to authorized services.

● Insurance Verification and Billing:

○ Maintaining accurate and up-to-date client insurance information through monthly verification.

○ Requesting additional units for clients when medically necessary and adhering to proper CPT codes.

○ Reconciling insurance payments, checks, e-checks, and copays to ensure financial accuracy.

● Client Profile and Documentation Management:

○ Keeping client demographics and all authorization-related documents current and readily accessible.

○ Ensuring client files are complete and meet HIPAA compliance standards.

○ Ensuring all information needed for authorization of services is completed

○ Uploading approved authorizations and relevant documentation to the Central Reach system promptly

● Quality assurance:

○ Completing Insurance audits monthly.

○ Ensuring commercial clients have ABA as a covered benefit.

○ Assisting with analysis of quality assurance measures.

○ Distributing and analyzing client/stakeholder satisfaction surveys.

○ Ensuring that files are secured and protected each day.

○ Ensuring the persons served have a clear understanding of their rights.

○ Acknowledging and respecting the rights of persons served at all times.

● Process Improvement:

○ Collaborating with team members to identify and analyze authorization workflows for potential bottlenecks and opportunities for optimization.

○ Proposing and implementing process improvements to achieve faster turnaround times, reduce errors, and increase efficiency.

○ Utilizing data analysis and best practices to continuously refine authorization processes.


Qualifications:

● Bachelor's or Associate's degree in healthcare administration, business, or a related field preferred.

● Minimum of 1-2 years of experience working with insurance pre-authorizations and billing in a healthcare setting.

● Strong analytical and problem-solving skills with a passion for process improvement.

● Excellent communication and interpersonal skills with the ability to build rapport with clients, families, and colleagues.

● Proficiency in Microsoft Office Suite, healthcare EMR systems, and data analysis tools.

● Demonstrated commitment to providing exceptional customer service and exceeding client expectations.

● Adherence to HIPAA regulations and patient confidentiality standards.

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