Authorization Specialist II, RCM

Authorization Specialist II, RCM

The Authorization Specialist II, RCM is a position that performs the authorization requests for all insurances. In this role, you will report to the Authorization Manager, RCM.

Duties / Responsibilities :

Checking eligibility / benefits on patients as needed : Upon intake if not previously done for all patients, monthly on patients with non-Medicaid insurances, and at the beginning of each month where prior authorization is not required

At the beginning of every new year, obtaining details on eligibility, patients deductible and out of pocket costs

Communicating any patients that will have a patient responsibility with the appropriate staff so they can verify the patient will want services and to inform field staff to correctly fill out the consents

Tracking and obtaining all authorizations for all locations, along with reauthorization throughout duration of patient care

Data entering all authorization information into the system

Verifying accuracy in payor setup in EMR for all active policies

Maintain electronic record of all authorizations

Run reports daily, weekly, and monthly for department

Communicate with both internal and external customers to ensure authorizations are utilized accurately

Determine through eligibility and payer knowledge if the company can service a patient

Appeal denials as required by payer, including appeals through the health commission or applicable governing body

Attend regular meetings with branches as needed to ensure open communication

Perform other duties as assigned

Required Skills / Abilities / Knowledge :

Excellent verbal and written communication skills with ability to communicate across all levels of authority within company

Excellent organization, problem solving, and project management skills

Able to independently file appeals with multiple payors

Troubleshoot eligibility issues with internal teams as it relates to insurance coverage

Able to effectively deal with change

Understand the patients benefits throughout the patient admission

Able to complete projects within specific timetables

Able to successfully interact with people in face-to-face situations as well as by telephone in a professional and effective manner

Education / Experience / Licenses / Certifications :

High school or GED diploma required

Minimum of two years' experience in health-related authorization and eligibility required

Physical Requirements :

You are not required to disclose information about physical or mental limitations that you believe will not interfere with your ability to do the job. However, you should disclose any physical or mental impairment for which special arrangements or accommodations are needed to enable you to perform the essential functions of the job. Your description of any impairment and suggestions for reasonable accommodations will be considered in providing reasonable accommodations.

Requires the ability to write, dictate or use a keyboard to communicate directives

Utilizes proper body mechanics in multiple environments

Requires the ability to function in multiple environments

FLSA Status

: Non-exempt

EEO Status

: Administrative Support Workers

Benefits + Perks of Joining the Team Select Family :

Medical, Dental, and Vision Insurance

Paid Time Off and Paid Sick Time

401(k)

Referral Program

Pay Range :

$15.00 - $20.00 / hour

Team Select Home Care reserves the right to change the above job description and qualifications without notice. Team Select Home Care will not discriminate against you on the basis of race, color, religion, national origin, sex, sexual preference, disability, political belief, veteran status, age, or any other status protected by law. Team Select Home Care is an employment-at-will employer.