Authorization and Insurance Specialist

Centria Healthcare • Farmington Hills, MI

3d • $17 - $20

About The Position

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.

Requirements

• High School diploma or equivalent, minimum requirement
• 1—2 years of call center or customer service experience
• Minimum typing proficiency of 55 words per minute with errorless typing
• Basic computer skills
• Working knowledge of laptop/desktop PC
• Proficiency in Microsoft Suite
• Proficiency in G Suite
• Ability to follow written instructions
• Ability to use computers and computer/software programs
• Ability to communicate expressively and receptively
• 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.

Nice To Haves

• 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

Responsibilities

• Work collaboratively with the Intake Team to verify insurance coverage and benefit details for ABA Therapy.
• Confirm authorization requirements per payor for all incoming leads.
• Request and track commercial and Medicaid authorizations.
• Maintain active insurance coverage(s) for all clients.
• Ability to communicate effectively, both oral and written, with internal staff, clients/guardians, and payors/insurance companies.
• Ensure strict confidentiality of client records according to policy and procedures; adhere to HIPPA regulations.
• Make administrative and procedural decisions and judgments on confidential issues.
• Knowledge of computer data entry systems, protocols, and procedures.
• Answer and direct phone calls to appropriate parties and handle time-sensitive issues from internal staff.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED