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Authorization Specialist

2 months ago

Westerville, United States Ciena Healthcare Management, Inc. Full time

The primary purpose of the Authorization Specialist is to centrally facilitate the procurement of insurance re-authorizations from our Managed Care Partners for continued skilled services in the Skilled Nursing Facility setting. This will be done through quality validations of obtained authorizations as well as continuous education and opportunity feedback to a multi-disciplinary team with the underlying objective of managing the cost of care and providing timely and accurate information to our Managed Care partners. This is to be done in accordance with current applicable federal, state, and local standards, guidelines and regulations, the established policy and procedures, and as may be directed by the Authorization Director.

Join us with an attractive benefits offering:

  • Competitive pay
  • Medical, dental, and vision insurance
  • 401K with matching funds
  • Life Insurance
  • Employee discounts
  • Tuition Reimbursement
  • Student Loan Reimbursement
Responsibilities:
  • Centrally facilitates the successful procurement of insurance re-authorizations extensions with the Managed Care Partners.
  • Gathers the necessary documentation required by the Managed Care Partner to clearly paint the functional picture of the resident and demonstrate the continued need for skilled services in the SNF setting.
  • Accountable for a designated caseload and plans effectively to meet demands and support resources procuring re-authorizations.
  • Ensure feedback relevant to successful re-authorization procurement is obtained from our Managed Care partners.
  • Centralized resource for assigned facilities to ensure standardized and consistent procurement of re-authorizations.
  • Current working knowledge of all Managed Care contracts including procedures for Authorizations and Re-authorizations based on the contracts.
  • Manage the Authorization Dashboard in PCC and enter the re-authorization numbers on Authorization Dashboard when obtained.
  • Data collection and tracking to analyze our success rate with resident length of stay, management of our Managed Care residents, and communication to our Managed Care Partners.
  • Communicates with specific team members in the facilities and Managed Care Partners to optimize the resident's highest practical level of independence, optimize length of stay, and ensure reimbursement for the services provided.
Requirements:
  • Must have a high school diploma or equivalent.
  • Healthcare experience with familiarity with medical terminology a plus. Experience in the long-term care provider sector is preferred.
  • Must be able to manage electronic medical records and rehab software programs.
  • Must have the strong communication skills and patience necessary to effect change.

Ciena Healthcare

We are a provider of skilled nursing, subacute, rehabilitative, and assisted living services dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana.

We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. If you have a passion for improving the lives of those around you and working with others who feel the same way.