Authorization and Benefits Specialist

Company Description

At Therapy & Beyond we approach the needs of each patient both individually and as part of a dynamic interdisciplinary team working with experts in applied behavior analysis (ABA) therapy, speech-language pathology, occupational therapy, and counseling. We love helping individuals reach their full potential by supporting not only the patient but also their family. We are passionate about what we do while remaining true to our core values of excellence, responsibility, integrity, and professionalism.

Job Description

The Authorization and Benefits Specialist is responsible for obtaining benefits and preauthorization from payors, following up on authorization requests, obtaining retroactive authorizations, and maintaining authorizations for new patients.

Job-specific Functions

Responsibilities include initiating, following up, and securing benefits and authorizations sent to third-party payors. Obtain authorization renewals

Track and follow up on all pending authorizations at 3, 7,14, 30 days depending upon payer guidelines to expedite the claims process and avoid lost revenue

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

Verify authorization quantities and effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systems

Create and maintain centralized payer master list to record requirements by payer

Create a payer authorization manual and tips to securing authorization

Identify opportunities to improve authorization efficiencies electronically

Review and interpret insurance group pre-certification requirements, ensuring that proper pre-authorizations have been obtained from the payer and documented.

Interact with patients and third-party insurance companies to secure retroactive insurance coverage and authorizations, and/or single case agreements for out of network patients

Qualifications

Education: High School Diploma or GED required; some college preferred.

Experience: A minimum of 2 years in benefit verification and authorizations preferred

Skills: Communicates clearly and concisely, verbally and in writing, establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.

Ability to sustain prolonged sitting and extended computer use. Requires working under some stressful conditions to meet deadlines and to make quick decisions. Require hand-eye coordination and manual dexterity.

Additional Information

Pay Range: $19-$21 per hour