Prior Authorization Billing Specialist- Remote

Team Recovery Ohio LLC • Toledo, OH

20h • Remote

About The Position

About Team Recovery: Team Recovery is an addiction treatment center dedicated to supporting individuals affected by substance use and mental health disorders. We offer a full continuum of care, including inpatient detox, residential treatment, outpatient services, and recovery housing, designed to meet people where they are in their recovery journey. Our team is made up of professionals, many with lived experience, who understand the challenges of addiction and the power of connection. With a mission to improve lives and a vision to redefine treatment, we're committed to creating lasting change in the communities we serve. Team Recovery is more than a treatment center. We're a new approach to an old problem.
Job Summary: The Prior Authorization Specialist is responsible for managing the pre-authorization processes to ensure the timely submission of requests to insurance companies for healthcare services provided. They will work closely with healthcare providers, insurance companies, and other stakeholders to ensure compliance with regulatory standards and maximize revenue collection in a timely and efficient manner.

Requirements

• High School Diploma or GED required.
• 3 or more years of experience and a strong understanding of the credentialing, prior-authorization, and insurance reimbursement processes preferred.
• Excellent written and verbal communication skills.
• Sound problem-solving and decision-making skills with the ability to work under pressure, manage conflict, and appropriately prioritize responsibilities and deadlines.
• Proficiency in Microsoft Office Suite & Google Workplace.
• Proficiency in using billing software and Electronic Medical Records (EMR) systems.
• In-depth knowledge of Credentialing systems and procedures, including MITS, PNM, and more.
• In-depth knowledge of Medical Billing and Coding systems and procedures, including CPT, ICD-10, HCPCS coding, and more.
• Experience submitting and following up on Prior-Authorizations.
• Proficiency with insurance guidelines, including Medicaid and private insurance carriers.
• Knowledge of Federal, State and Municipal laws and/or regulations that regulate the treatment of alcoholism and drug addiction, including:
• Confidentiality & Privacy
• Patient Rights
• Professional Code of Ethics
• Discrimination
• Ability to pass a pre-employment background check and drug screen required.

Nice To Haves

• Associates or Bachelors degree in Healthcare Administration preferred.
• Behavioral Health and Substance Use Disorder treatment experience preferred.

Responsibilities

• Obtain prior authorizations from insurance companies for behavioral health and addiction recovery services and medications.
• Review client medical records and treatment plans to determine the medical necessity of requested services.
• Submit prior authorization requests to insurance companies and follow up on the status of pending requests.
• Communicate with healthcare providers, insurance companies, and clients to gather necessary information for prior authorizations.
• Ensure compliance with insurance requirements and guidelines for prior authorizations.
• Maintain accurate records of prior authorization requests and approvals.
• Stay up to date on insurance policies and guidelines related to addiction recovery services.
• Collaborate with the clinical team and billing department to facilitate the prior authorization process.
• Process and submit insurance claims
• Verify insurance coverage and benefits for clients seeking behavioral health and addiction recovery treatment.
• Review client accounts and ensure accurate billing and coding of services provided.
• Follow up on unpaid claims and denials, and resubmit claims as necessary.
• Communicate with insurance companies, clients, and healthcare providers to resolve billing issues.
• Stay up-to-date on insurance regulations and billing guidelines related to behavioral health and addiction recovery services.
• Maintain client confidentiality, adhere to 42 CFR, and HIPAA regulations.
• Collaborate with revenue cycle management, finance, and clinical staff to ensure accurate and timely billing practices.
• Provide excellent customer service to clients regarding billing inquiries and concerns.
• Attend required staff training and development meetings.
• Flexibility to adapt to schedule changes and assumption of responsibilities not delineated in the job description which are related to work as a member of an addiction treatment team.

Benefits

• Competitive Pay + 401(k) with Employer Match - Plan for your future with confidence.
• Generous Paid Time Off - We value work-life balance and encourage time to recharge.
• Tuition Reimbursement - Invest in your growth with support for ongoing education.
• Comprehensive Medical, Dental & Vision Insurance - Your health and well-being matter.
• Employee Assistance Program - Get confidential support when you need it most.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED