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Senior Authorization Coordinator

2 months ago

Seal Beach, California, United States Aveanna Full time

Position Title: Lead Authorization Specialist

Job Overview: The Lead Authorization Specialist plays a pivotal role in overseeing the insurance authorization workflow for patient services. This position is crucial in ensuring seamless communication between healthcare providers, clinical teams, and insurance companies to secure necessary approvals and facilitate efficient payment processes.

Key Responsibilities:

  • Supervise the insurance authorization process for patient services, ensuring timely approvals are achieved.
  • Assess and enhance the performance of the authorization team, implementing performance improvement strategies as needed.
  • Handle escalations from team members, providing guidance for resolution and necessary follow-up.
  • Establish effective communication with insurance providers upon receiving referral details from clinical teams, particularly for services requiring pre-certification.
  • Engage proactively with insurance carriers to ensure the prompt receipt of all essential payment information, streamlining authorization processing.
  • Keep the authorization team updated on any changes in insurance requirements related to authorization and eligibility.
  • Verify the completeness of submissions, ensuring adherence to accuracy and compliance standards.
  • Maintain consistent communication with the authorization team throughout the authorization process, providing regular updates on service request statuses.
  • Identify and report potential issues that may lead to authorization lapses, offering insights and recommendations for improvement.
  • Support, train, and mentor Authorization Specialists.

Compliance: Adhere to Aveanna's Compliance Program, following all regulatory policies and guidelines set by accrediting agencies.

Qualifications:

  • High school diploma or GED.
  • Minimum of 2 years of relevant experience.
  • Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).

Preferred Qualifications:

  • Bachelor's degree in healthcare or a related field.
  • Bilingual; proficiency in Spanish is advantageous.
  • Additional experience in healthcare, medical office, or customer service settings.

Skills and Abilities:

  • Strong organizational skills with a keen attention to detail.
  • Excellent written and verbal communication abilities.
  • Ability to work independently and collaboratively within a team.
  • Proficient in exercising effective judgment and sensitivity to changing situations.

Physical Requirements:

  • Ability to communicate effectively in English.
  • Occasional lifting and carrying of up to 25 pounds.
  • Prolonged periods of walking, standing, and bending.

Work Environment: This role is performed in an office setting during standard operating hours, with potential exposure to various conditions.

Additional Information: This job description is intended to provide a general overview of the responsibilities and requirements of the position. Duties and responsibilities may change as needed.

Vaccine Requirement: Employees must comply with all health-related requirements in relevant jurisdictions, including vaccinations and testing, with exemptions for medical or religious reasons as applicable.