Authorization Specialist

New England Life Care•Canton, MA

2d•Remote

About The Position

New England Life Care (NELC) is a growing non-profit home infusion therapy company serving New England. As a hospital collaborative, NELC is committed to patient-focused care, quality, and service. This is a Remote Authorization Specialist position, with a normal schedule of Monday – Friday from 8:30am to 5:00pm. The role is responsible for obtaining and maintaining prior authorization status for patient medications/therapies, working closely with the clinical review department for necessary documentation and supporting the billing department to meet payer requirements. NELC fosters a diverse and inclusive workplace and encourages applications even if experience doesn't cover every qualification.

Requirements

High School Diploma, or equivalent required.
Minimum of two years authorization, reimbursement or claims processing experience required.
Excellent organizational skills required.
Basic accounting transaction/analyst skills required.
Demonstrated ability to identify research and solve problems required.
Ability to work independently as well as part of a team required.
Practical experience with Microsoft computer systems and applications, to include Word & Excel

Nice To Haves

Practical experience with medical terminology; CPT, ICD-9 and HCPC coding preferred.
Practical experience with Medicare, Medicaid and third-party payor contracts preferred.
Knowledge of HIPAA Privacy and Security requirements preferred.

Responsibilities

Achieve performance appraisals with "meets expectations" or better
Maintain a good record of attendance and punctuality
No Performance management deficiencies in the period
Demonstrate independence and competence to follow Authorization Request process for all payers.
Demonstrate independence and competence to follow the Re-Authorization process
Demonstrate independence and competence to follow the Specialty process
Demonstrate independence and competence on all MOA's and therapies
Demonstrate independence and competence and ability to Authorize all services, document and communicate accurately on all changes of service, in CPR+ and to appropriate departments.
Demonstrate independence and competence and ability to work through a TO DO without the need for extended timeframes.
Demonstrates the ability to work within a team and independently with confident communication skills and exceptional customer service skills.
Completes three continuing education programs in the period specifically related to professional development, LEAN and/or leadership development.