Authorization Specialist I, RCM

Team Select Home Care•Salem, NH

About The Position

The Authorization Specialist performs authorization requests for all insurances and reports directly to the Authorization Manager, RCM. The role checks patient eligibility and benefits, obtains and tracks authorizations and reauthorizations, records authorization information, verifies payor setup in the EMR, maintains electronic authorization records, runs departmental reports, and communicates with internal and external customers to support accurate use of authorizations. The role may also perform other duties as assigned. This position requires effective communication, organization, problem-solving, adaptability, and the ability to manage tasks within specific timetables. The employee must interact professionally with patients, clients, coworkers, and field-based leadership, including in stressful situations, and maintain confidentiality of sensitive information. A high school diploma or equivalent is required. The position requires the ability to write, dictate, or use a keyboard to communicate directives, use proper body mechanics in multiple environments, and function in multiple environments. Team Select Home Care may change the job description and qualifications without notice. The employer states it is employment-at-will and will not discriminate on legally protected grounds.

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, patient deductible information, and out-of-pocket costs.
Communicate anticipated patient responsibility to appropriate staff so they can confirm the patient wishes to receive 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 all authorization information into the system.
Verify accuracy of payor setup in the EMR for all active policies.
Maintain electronic records 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.