Authorizations Specialist

Caravel Autism Health•Green Bay, WI

About The Position

The Authorization Specialist is responsible for preparing and submitting detailed prior authorization requests, following up on requests, and appeals to insurance companies, including relevant clinical information and supporting documentation for ABA services. This position ensures that authorization requests are handled in a timely, efficient, and accurate manner. The Authorization Specialist requires excellent organization and communication skills, and an in-depth knowledge of ABA insurance guidelines. This position will work closely with staff throughout the organization and outside entities, including insurance companies, patients, and third-party providers and organizations for both authorization and medical record requests from authorized individuals while ensuring proper release procedures are followed. This position is expected to be familiar with HIPAA and other state and federal regulations.

Requirements

High school diploma or equivalent
At least two years of previous medical insurance, billing, or claims processing related experience.
Strong keyboarding and computer skills including MS Office (Word and Excel) experience at an intermediate level.
Knowledge of medical billing and ICD-10, and CPT coding, as well as knowledge of financial concepts related to authorizations, medical insurance, billing, and claims processing.
Ability to abide by ethical guidelines and policies, including strict adherence to confidentiality and HIPPA guidelines.
Excellent interpersonal skills, with the ability to communicate effectively with others.
Strong organizational skills, with the ability to multi-task and meet deadlines.
Demonstrates initiative, with the ability to manage self and workload.
Strong analytical and problem-solving abilities.
Exemplary customer service focus, for both internal and external clients.
Strong team player.
Displays professionalism and represents organization in a professional manner.

Nice To Haves

Prefer coursework and/or experience in medical health insurance and medical records management.
Experience addressing billing and claims processing or insurance authorization related to developmental disabilities, including Autism Spectrum Disorder, preferred.

Responsibilities

Manages ABA prior authorizations process start to finish. This includes communicating with the clinical team, insurance companies and billing team while following set authorization processes, including necessary appeals.
Maximizes revenue through thorough understanding and use of principles of ICD-10 and CPT Codes for treatment plans and ABA Therapy for authorizations.
Verifies benefits with insurance companies.
Maintains information/regulations of insurance utilization management policy and procedures and communicates changes to these policies and procedures with Manager.
Acts as a resource for Caravel for authorizations and insurance verification issues, providing guidance and information to support the benefits authorization and reimbursement process.
Provides information to client families about the authorization process, including Caravel’s process for seeking authorization and updates on individual authorization status.
Reviews denials and submits timely appeals as needed.
Maintains client medical record and accurate billing information in the practice management systems.
Perform monthly eligibility and enrollment verification for all clients. This includes communicating with families, the clinical team, the billing team, and the insurance company to process necessary funding changes in a timely matter.
Review, prepares and submits patient medical records upon appropriate written request from authorized parties, in alignment with all applicable guidelines and regulations.
Maintains strict confidentiality; adheres to all HIPAA guidelines/regulations.
Excellent oral, written, and interpersonal communications skills.