Healthcare Authorization Specialist

3 months ago

Sarasota, United States Opal Autism Centers Full time
Job DescriptionJob DescriptionOpal Autism Center's mission is to help children succeed. We’re a different kind of therapy provider. We partner with our families. We prioritize our caregivers. We’re interested in expanding access to services for all families and we use technology in support of those priorities. 

*Who you are*

We are looking for a driven self-starter to join our Revenue Cycle Team. The Healthcare Authorization Specialist supports the billing department in all areas of revenue cycle management including verifying eligibility and benefits, collect and review referrals and pre-authorizations, audit data to ensure claims are clean, ensure the patient’s medical information is accurate and up to date, examine patient information for accuracy and request any missing information, assist providers in developing patient payment plans, assist billing specialists with billing tasks including investigating and appealing denied claims.
 
To succeed in this role, the Healthcare Authorization Specialist must possess in-depth knowledge of the revenue cycle process and the ability to quickly learn the nuances and codes of ABA/autism billing as well as the various EHR systems and online payer portals used in the in the field of ABA. This is a remote-hybrid position, which will require future on-site work in Sarasota, FL.

The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as communicating with clients and various insurance agents will form a large part of the job. In this position, you will be responsible for a variety of tasks requiring data analysis, in-depth evaluation, multi-tasking, and sound judgment.
​​​​​​
*What you'll do*
 
  • Responsible for the timely verification of insurance benefits provided via websites and/or calling the payor.
  • Obtain precertification and authorizations for services being rendered by deadlines
  • Review and resolves prior authorization/precertification/referral issues that are not valid and contacts insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial.
  • Identify and forward potential reimbursement problems with the Billing Team.
  • Initiating benefits verification by reviewing patient data and insurance material, including identifying missing information and following up with points of contact to resolve information gaps
  • Verifying benefits for each assigned patient case and documenting any requirements for reimbursement including copays, coinsurance, utilization management requirements, qualifications / restrictions, and prior authorization requirements
  • Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations retrospectively and/or requesting single case agreements for out of network patients
  • Work directly with providers to secure clinical notes and other supporting documentation required to obtain authorizations timely
  • Identifying clarifying questions to get the best results on the first call
  • Entering data and notes in an accurate manner
  • Effectively communicating next steps to team
  • Following HIPAA regulations when handling client information
  • Communicating and working effectively with team members
  • Other duties as assigned
*Here are some of our ideas about what the ideal candidate will be all about:*
 
  •  Our ideal candidate is an energetic, outgoing, recent graduate looking to break into the healthcare industry
  • You have a passion for excellent customer service and patient experience
  • telling the story of a business to the community and generating leads, especially through online tools.
  • You have passions that you've built into your studies and your life. You delve deep into your work; you are not one to barely scratch the surface, just enough to check off a box.
  • You are a fluid writer and an eloquent speaker. Send us a cover letter that showcases your style, future goals, and that does a good job of conveying who you are on both a personal and professional level.
  • You are looking for a career to excel at because you are a driven person and are tired of simply collecting a paycheck while the hours tick by on the clock.
  • You are reinforced by beating your own best, having a seat at the table, and offering your brilliant and innovative mind to solve problems and contributing to the company’s overall success.
  • You are a natural born leader, but you value feedback for growth and can manage expectations well.
  • You are smart. Quick. Curious. Ambitious. Dedicated. People would describe you as generous and compassionate while also tenacious and ambitious.
  • You are able to work full-time, Monday-Friday during regular business hours. 
  • Must currently reside in the state of Florida due to the remote-hybrid position requirements

*If you are interested in this position, please do the following: briefly address our criteria above in a customized cover letter and make the case for yourself
 

Opal Autism Centers is committed to providing equal employment opportunities to all qualified individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, or any other protected status. We value diversity and inclusion in our workplace. By applying for this position, you acknowledge and agree to the above statement.

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