Authorization and Insurance Specialist

Job Description

Job Description

About Centria Healthcare :

Every child deserves the brightest future and Centria Autism Services is on a mission to help children with Autism Spectrum Disorder (ASD) have the best developmental experience possible while acquiring the skills to succeed in the world on their own terms. Too many children with ASD are untreated or undertreated and Centria is committed to reaching every child in need and their families with interventions based on the principles of Applied Behavior Analysis that meet – and exceed best practices. Our Optimal Outcomes Model(TM) looks at the whole-child, engages families in aspirational treatment planning and leverages team-based care to allow BCBA's to focus on clinical issues and support Centria's dedication to quality, family satisfaction and developmental outcomes. Founded in 2009, Centria now operates in 13 states and is working hard to develop approaches to sustain quality while reaching tens of thousands of children across the country; we use data-driven analytics and sophisticated software platforms to constantly evaluate our quality and performance, and develop new approaches to supporting our clients and their families on their journey.

Job Purpose

The Authorization and Insurance – Team Lead ensures that authorizations are submitted accurately, timely, and follow up to facilitate approval within payor standards. The Authorization and Insurance – Team Lead will also ensure all corresponding team members' work is assigned and disseminated accordingly while serving as a point of escalation for team members.

Success Measures

Success measures include adherence to Centria policies, flawless execution of tasks, a timely, positive customer service experience for team members, and a high level of compliance. Success also includes meeting or exceeding personal qualitative and quantitative key performance indicator (KPI) metrics.

Duties and Responsibilities

• Process and procedure expert for assigned / applicable insurance policies.
• Ability to step in and lead team huddles.
• Ability to step in and lead direct reports in RCM Manager's absence.
• Audit / track accuracy of Insurance Verification, Eligibility and Authorizations – scope and frequency.
• Knowledge of payor contracts in accordance with guidelines for Financial Clearance.
• Coordinate with related internal staff on front-end "fails" identified.
• Train new team members and assist in any coaching opportunities.
• Work independently and collaborate in a team environment.
• Assist in situations that require additional care and knowledge (new payor).
• Ensure strict confidentiality of client records according to policy and procedures.
• Make administrative and procedural decisions and judgments on sensitive, confidential issues.
• Knowledge of computer data entry systems, protocols, and procedures.
• Communicate effectively, both oral and written, to peers, team members, and payors / insurance companies.
• Collaborate with RCM Billing / AR Teams in collection efforts from respective payors.
• Collaborate with denial management team.
• Other duties as assigned by the RCM Leadership Team.

Managerial Responsibility

This role is responsible for :

Role / Team / Department

Qualifications

Education

High School Diploma or equivalent, minimum requirement

Work Experience

Equipment and Technology

Other Competency Requirements

Knowledge and Skills

Working Conditions

Physical Demands

While performing the duties of this job, physical requirements such as bending, reaching, and lifting up to 30 pounds may be required. This role will require sitting most of the day as well as walking and standing when needed. This role will require close visual activity on multiple computer screens or monitors and the ability to analyze data and figures on a screen.

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, Veteran status, or disability status. This job description is not intended to be an exhaustive list of qualifications, skills, efforts, duties, responsibilities, or working conditions associated with the position. Centria reserves the right to amend this job description at any time, with or without written notice.