Authorization Specialist I, RCM

Team Select Home Care•Denver, CO

About The Position

The Authorization Specialist performs authorization requests for all insurance plans and reports directly to the Authorization Manager, RCM. The role supports authorization and eligibility processes across all locations, maintains authorization records and information in the system, and communicates with internal and external customers to ensure authorizations are used accurately. The position requires strong communication, organization, problem-solving, adaptability, confidentiality, and the ability to work effectively with clients and coworkers. It also requires functioning in multiple environments and using writing, dictation, or a keyboard to communicate directives.

Requirements

High school diploma or equivalent.
Excellent verbal and written communication skills, including the ability to communicate across all levels of field-based leadership.
Strong organization and problem-solving abilities.
Ability to deal effectively with change.
Ability to complete projects and tasks within specific timetables.
Ability to interact professionally and effectively with people face-to-face and by telephone.
Ability to communicate verbally and in writing and maintain confidentiality of sensitive information.
Ability to use logical and scientific thinking to interpret technical data and solve a broad range of problems, including using complex techniques to assess situations.
Ability to interpret, adapt, and react calmly under stressful conditions.
Ability to relate cooperatively and constructively with clients and coworkers.
Ability to write, dictate, or use a keyboard to communicate directives.
Ability to use proper body mechanics and function in multiple environments.

Responsibilities

Check patient eligibility and benefits as needed, including at intake when not previously completed; monthly for patients with non-Medicaid insurance; and at the beginning of each month when prior authorization is not required.
At the beginning of each new year, obtain eligibility details and information about patients’ deductibles and out-of-pocket costs.
Communicate patient-responsibility information to appropriate staff so they can verify the patient wants services and inform field staff to complete consents correctly.
Track and obtain authorizations for all locations, including reauthorizations throughout the duration of patient care.
Enter authorization information into the system.
Verify the accuracy of payer setup in the EMR for all active policies.
Maintain an electronic record of all authorizations.
Run daily, weekly, and monthly reports for the department.
Communicate with internal and external customers to ensure authorizations are utilized accurately.
Perform other duties as assigned.