Authorization Specialist

Crossroads Treatment Centers•Greenville, SC

About The Position

Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Since 2005, Crossroads has been at the forefront of treating patients with opioid use disorder. Crossroads is a family of professionals dedicated to providing the most accessible, highest quality, evidence-based medication assisted treatment (MAT) options to combat the growing opioid epidemic and helping people with opioid use disorder start their path to recovery. This comprehensive approach to treatment, the gold standard in care for opioid use disorder, has been shown to prevent more deaths from overdose and lead to long-term recovery. We are committed to bringing critical services to communities across the U.S. to improve access to treatment for over 26,500 patients. Our clinics are all outpatient and office-based, with clinics in Georgia, Kentucky, New Jersey, North and South Carolina, Pennsylvania, Tennessee, Texas, and Virginia. As an equal opportunity employer, we celebrate diversity and are committed to an inclusive environment for all employees and patients. Day in the Life of an Authorization Specialist Review patient accounts flagged for prior authorization request needs. Will process authorizations by phone, fax, and portals for multiple payer types and various state Medicaid. Other duties will be obtaining retro authorizations, appeals, and reviewing medical charts for medical necessity. Research and processes eligibility requests according to business regulation, internal standards, and processing guidelines. Verifies the need for prior authorizations or the need for retro billing. Coordinates with internal departments to work changes in payor billing guidelines, updating the patient identification, other health insurance, provider identification and other files as necessary. Responsible for processing authorizations. Receiving approval for all services Crossroads provide. Research and appealing denied authorizations. Must possess a good working knowledge of payer eligibility guidelines, payer portals, and clearinghouses to ensure a complete verification of benefits. Responsible for tracking and organizing status of authorizations, inputting authorization numbers into the EMR, and scanning proof of authorization obtained into patients’ charts. Responsible for all missing authorization related denials to identify trends to improve reimbursement rates. Responsible to work all authorization requests within a 24/48-hour turnaround time from receipt. Understands and adheres to state and federal regulations and system policies regarding compliance, integrity, and ethical billing practices. Other duties as assigned.

Requirements

Must have had at least 4 years electronic insurance verification, real time eligibility, and/or billing experience in a hospital and/or physician office setting.
General Knowledge of HCPCS, CPT-4 and ICD9-10 coding and/or medical terminology.
Familiar with multiple payer requirements and regulations for utilizing benefits.
Must possess a good working knowledge of payer eligibility guidelines, payer portals, and clearinghouses to ensure a complete verification of benefits.

Responsibilities

Review patient accounts flagged for prior authorization request needs.
Process authorizations by phone, fax, and portals for multiple payer types and various state Medicaid.
Obtain retro authorizations, appeals, and reviewing medical charts for medical necessity.
Research and processes eligibility requests according to business regulation, internal standards, and processing guidelines.
Verifies the need for prior authorizations or the need for retro billing.
Coordinates with internal departments to work changes in payor billing guidelines, updating the patient identification, other health insurance, provider identification and other files as necessary.
Responsible for processing authorizations.
Receiving approval for all services Crossroads provide.
Research and appealing denied authorizations.
Responsible for tracking and organizing status of authorizations, inputting authorization numbers into the EMR, and scanning proof of authorization obtained into patients’ charts.
Responsible for all missing authorization related denials to identify trends to improve reimbursement rates.
Responsible to work all authorization requests within a 24/48-hour turnaround time from receipt.
Understands and adheres to state and federal regulations and system policies regarding compliance, integrity, and ethical billing practices.
Other duties as assigned.

Benefits

Have a daily impact on many lives.
Excellent training if you are new to this field.
Mileage reimbursement (if applicable) Crossroads matches the current IRS mileage reimbursement rate.
Community events that promote belonging and education. Includes but not limited to community cook outs, various fairs related to addiction treatment and outreach, parades, addiction awareness for schools, and holiday events.
Opportunity to save lives everyday!
Medical, Dental, and Vision Insurance
PTO
Variety of 401K options including a match program with no vesture period
Annual Continuing Education Allowance (in related field)
Life Insurance
Short/Long Term Disability
Paid maternity/paternity leave
Mental Health Day
Calm subscription for all employees