Job Title: Authorization Specialist

Department: Fiscal

Reports To: Director Reimbursement

Location: 760 East 160th Street Bronx NY

Job Summary:

The primary responsibility of the Authorization Specialist is to obtain, maintain, and track program authorizations for services rendered to the client. This includes obtaining clinical documentation from Program Counselors, Managers, Directors, and/or AVP and submission of this information to the client's insurance company. The Authorization Specialist works closely with the billing team to address any authorization denials to include follow-up, appeals, and scheduling peer-to-peer meetings with the insurance company for resolution. The Authorization Specialist is the Liaison between the Program and the Billing Department. The Authorization Specialist will to perform all job duties as assigned and demonstrate the capability to execute all tasks accurately. This role works at the Program Level to ensure authorizations are obtained in a timely manner, and the Agency remains in compliance with all payer Authorization Policies and Procedures.

Primary Duties & Responsibilities include, but are not limited to:

• Act as a Liaison between the Program and Billing Department.
• Obtain, maintain and track prior Authorizations for services rendered at the Program.
• Work with Program Staff to obtain clinical documentation and client information in a timely manner.
• Keep the Director of Reimbursement aware of any delays in obtaining requested documentation.
• Submit the Level of Care Determination (LOCADTR) and Initial Notification of Treatment Plan if client’s insurance coverage begins after the client begins the program.
• Work with Billing Team to keep Program Roster updated with authorization status.
• Track all Authorizations on the Program Roster to ensure all authorizations are active.
• Work closely with Programs regarding Authorization expiration dates to ensure clinical documentation is received within the allotted timeframe.
• Authorization Denial Management - meet with billing team weekly to review denials to ensure claims are being appealed and/or corrected within timely filing limits.
• Submit appeals for Authorization denials and schedule peer-to-peer meetings as needed.
• Work with billing team to verify insurance monthly to confirm eligibility and to ensure authorization requests are sent to the correct insurance company.
• Follow up on late and/or delayed clinical documentation to avoid timely filing denials.
• Provide feedback to AVP and Director of Reimbursement of any inaccuracies related to Authorizations.
• Create and provide Authorization tracking reports as needed.
• Organize monthly Authorization meetings with Program Leadership and/or Billing Leadership.
• Assist with other tasks related to Authorizations; Denials and/or Billing as needed.

Qualification/Criteria:

• One-year prior experience working in behavioral health administration and/or Program setting.
• Knowledge of medical technology.
• Basic computer skills including Excel and PowerPoint
• Able to pay close attention to detail.

Education:

• High School Diploma or Associate Degree