Authorization and Insurance Specialist

Position Summary

The Financial Clearance Authorization and Insurance Specialist position is responsible for collecting client demographic and insurance information, processing that information for collections and reimbursement, and the timely and successful submission of pre-authorizations (pre-auths) of services to insurance payors. This directly correlates to mitigating and reducing bad debt for Centria Autism by initiating the continuous review and follow-up of the eligibility and pre-authorization for Diagnostic Evaluations, Initial Assessments, and Ongoing Treatment (if applicable by payor/market). The Authorization and Insurance Team should identify and understand all payor rules for the proper adjudication of the pre-auths and verification of ABA Therapy insurance coverage and benefits for our client families when needed. They are responsible for managing the overall pre-auth process, which includes but is not limited to following up with the Operations/Clinical Teams and coordinating all applicable documentation and action needed to complete the securing of an approved authorization. The Authorization and Insurance Team provides superior customer service and support to the Operations Teams and all other Revenue Cycle Management/Centria Autism teams that provide services and support to our client families. And most importantly always conduct themselves in a manner that supports our mission.

Success Measures

Success measures include adherence to Centria policies, flawless execution of tasks, and meeting or exceeding personal qualitative and quantitative key performance indicator (KPI) metrics.

Duties and Responsibilities

The below reflects the essential functions considered necessary for this role and shall not be construed as a detailed description of all work requirements inherent in the job or assigned by supervisory personnel. This job description is used as a guide only and not inclusive of all responsibilities and job duties.

1. Work collaboratively with the Intake Team to verify insurance coverage and benefit details for ABA Therapy.

2. Confirm authorization requirements per payor for all incoming leads.

3. Request and track commercial and Medicaid authorizations.

4. Maintain active insurance coverage(s) for all clients.

5. Ability to communicate effectively, both oral and written, with internal staff, clients/guardians, and payors/insurance companies.

6. Ensure strict confidentiality of client records according to policy and procedures; adhere to HIPPA regulations.

7. Make administrative and procedural decisions and judgments on confidential issues.

8. Knowledge of computer data entry systems, protocols, and procedures.

9. Answer and direct phone calls to appropriate parties and handle time-sensitive issues from internal staff.

10. Compliance with Centria’s Code of Conduct, policies and procedures, and Federal and State laws.

11. Responsibility to report violations of Company policies or the Code of Conduct.

Pay

$17.00 - $20.00 plus bonus

Qualifications

These guidelines can be used to make a list of qualifications required (or preferred) to perform the job successfully.

Education/Licenses

High School diploma or equivalent, minimum requirement

Work Experience

• 1—2 years of call center or customer service experience

• Minimum typing proficiency of 55 words per minute with errorless typing

• Knowledge of in-state and out-of-state commercial insurance plans, preferred

• Working knowledge of ABA Therapy regarding frequency and Current Procedural Terminology (CPT) codes, preferred

• Knowledge of Michigan Medicaid, preferred

Equipment and Technology Requirements

• Basic computer skills • Working knowledge of laptop/desktop PC

• Proficiency in Microsoft Suite

• Proficiency in G Suite

Other Competency Requirements

An initial assessment of competency will be completed during the interview period and evaluated on an ongoing basis.

• Ability to follow written instructions

• Ability to use computers and computer/software programs

• Ability to communicate expressively and receptively

Knowledge and Skills

• Proficient in Microsoft Office Suite, especially spreadsheet programs;

• Superb customer service and phone etiquette skills;

• Must be highly organized and possess strong analytical and overall personnel management skills;

• Ability to apply and adopt practices and techniques to the specifications set by senior leadership;

• Effective communication skills, both written and verbal, with internal and external stakeholders;

• Ability to build rapport with team members, explain complicated information in an approachable and easily understood manner, effectively handle challenging phone conversations, and represent the Centria brand;

• Ability to organize, prioritize and handle multiple tasks, adhere to established deadlines, and produce work that consistently meets or exceeds team benchmarks;

• Results-driven with the aptitude to apply critical thinking skills and problem-solving;

• Proven adaptability with a willingness to work both collaboratively and individually to achieve desired business outcomes;

• Excellent interpersonal, customer relationship, and listening skills;

• Demonstrated strong work ethic with attention to detail, accuracy, and quality;

• Established track record of generating error-free work.

Working Conditions

• Centria's office hours are Monday through Friday from 8:30 AM – 6:00 PM.

• Additional time or occasional shifts in schedule may be required to complete the above work or meet company objectives.

Physical Demands

While performing the duties of this job, physical requirements such as bending, reaching, lifting, pushing, or pulling up to 30 pounds may be required. This role will require sitting most of the day as well as walking and standing periodically. This role may require close visual acuity on computer screens or monitors and the ability to analyze data and figures on a screen

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, Veteran status, or disability status. This job description is not intended to be an exhaustive list of qualifications, skills, efforts, duties, responsibilities, or working conditions associated with the position. Centria reserves the right to amend this job description at any time, with or without written notice.