Authorization Specialist

Relief Mental Health • Oak Brook, IL

1d • Onsite

About The Position

The Authorization Specialist is responsible for managing prior authorizations and reauthorizations, tracking authorization status, and ensuring all necessary systems are updated. This role involves confirming medical necessity, negotiating single case agreements for out-of-network insurance cases, and establishing systems to maximize insurance coverage and reimbursement. The specialist will coordinate with clinics and providers to ensure documentation is tracked for reauthorization and continued care, and work with outside pharmacies for Spravato authorization and coverage. Additionally, the role involves collaborating on plan of care changes, monitoring medical policies for changes in criteria, assisting patients with enrollment in specific programs (Spravato REMS, Spravato Savings Program, JPAP), scheduling patients for the Spravato induction phase, and communicating with patients. A high level of professionalism, empathy, and positivity is expected.

Requirements

• 2 years of experience

Responsibilities

• Responsible for prior authorizations and reauthorization
• Responsible for tracking authorization status and adding to all necessary systems
• Responsible for confirming medical necessity
• Negotiates single case agreements for out of network insurance cases
• Establish and execute systems for maximizing insurance coverage and reimbursement
• Coordinates with clinics and providers to ensure all necessary documentation is being tracked and logged to allow for reauthorization and continued care
• Works with outside pharmacies for Spravato authorization and coverage
• Collaborates and facilitates needed changes to the plan of care/ level changes
• Continuously checks medical policies for changes to medical criteria needed for services
• Assist patients in enrolling into the Spravato REMS program and Spravato Savings Program, JPAP as needed
• Schedule patients for their Spravato induction phase
• Patient communication
• Exhibit a high level of professionalism, empathy, and positivity

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed