Billing and Authorization Specialist

CHD Careers•West Springfield, MA

22h•Onsite

About The Position

The Center for Human Development (CHD) is seeking a Billing and Authorization Specialist for its In-Home Therapy & Therapeutic Mentoring programs. This position is located in West Springfield and serves children and families across Hampden, Hampshire, Franklin, and Worcester Counties. The Billing and Authorization Specialist acts as a key liaison between the revenue cycle management team and clinical program staff, facilitating communication around authorizations, medical necessity requirements, and payer protocols. The role provides critical support to clinical authorization workflows, ensuring compliance with payer requirements and timely submission of authorization requests. Responsibilities include monitoring authorization statuses, tracking expirations, and initiating re-authorization processes as needed. The specialist will also be responsible for data and report maintenance with weekly tracking for all service lines requiring authorization, coordinating and managing the technical billing ticketing system, and triaging requests for efficient resolution. Additionally, the role involves assisting with the input and maintenance of referring provider data within the EHR system, navigating payer websites and technical resources to assist with user access, and providing cross-coverage for various internal CHD revenue cycle tasks to ensure seamless operational continuity. Administrative duties include answering and making calls, ordering supplies, and coordinating meetings.

Requirements

High school diploma or equivalent required.
3-5 years of experience in front-end revenue cycle within a healthcare setting, with a strong focus on authorizations.
Experience with electronic health records (EHR) systems, including document attachment and digital file organization.
Experience with Payer portals, including eligibility verification and securing authorizations.
Must complete and pass background record screening.

Nice To Haves

Previous experience with EHR systems.
Proficiency with Microsoft Office suite, specifically with strong capabilities in Excel.
Strong communication skills.
Ability to approach interactions with management and clinical staff in a pleasant and professional manner.

Responsibilities

Act as a key liaison between the revenue cycle management team and clinical program staff, facilitating communication around authorizations, medical necessity requirements, and payer protocols.
Provide critical support to clinical authorization workflows, ensuring compliance with payer requirements and timely submission of authorization requests.
Monitor authorization statuses, track expirations, and initiate re-authorization processes as needed.
Maintain data and reports with weekly tracking for all service lines which require an authorization.
Coordinate and manage the technical billing ticketing system, triaging requests to either outsourced teams or internal departments for efficient resolution.
Assist with the input and maintenance of referring provider data within the EHR system.
Navigate payer websites and technical resources to assist with user access, ensuring that program, clinical staff, and outsourced agencies have the necessary information and tools to resolve issues.
Provide cross-coverage for various internal CHD revenue cycle tasks, ensuring seamless operational continuity.
Perform administrative duties such as answering calls, making calls, ordering supplies, and coordinating meetings.