Reimbursement and Authorization Specialist

Job Description

Job Description

Position Title : Reimbursement / Authorization Specialist

FLSA Classification : Non-Exempt

Location : Central Office

Position Type : Full-Time

Reports to : AVP Revenue Cycle Management

EEOC Classification : Administrative Support Worker

Summary :

This position promotes the mission, vision, values and strategic plan of Neighborhood Service Organization and helps to achieve the strategic goals and objectives of the unit. The Reimbursement / Authorization Specialist's primary duties include ensuring the efficient and accurate processing of billings for mental health and substance abuse services provided by NSO physicians and clinical staff monthly, ensuring the preparation of monthly summarized reports, and re-billing of rejections

Responsibilities :

JOB KNOWLEDGE and COMPREHENSION

• Bills Medicare and other Commercial Insurance Carriers for NSO according to the billing schedule.
• Submits claims / encounters to DWIHN.
• Performs back-billing according to the billing Schedule.
• Investigates rejections / non-payments and re-bills if appropriate.
• Reviews and make any necessary changes to the monthly batch report printouts for billable activities to ensure accuracy.
• Enters and updates consumer insurance information monthly in ECO.
• Utilizes the Michigan Medicaid Eligibility line to verify Medicaid coverage and obtain third-party Insurance information.
• Utilizes various sites to verify insurance coverage.
• Obtains authorizations for all Non-Medicaid (Non-DWIHN) clients from insurance carriers, enters authorizations into ECO and notifies the treatment team of number of authorized services.
• Monitors, triages, and responds to the approval, denial, and request for more information of all DWIHN Authorizations for all services provided at NSO.
• Generates monthly listing of all NSO client's insurance status for review.

PRODUCTIVITY

Candidate Requirements :

Education : Bachelor’s degree or a combination of similar education and experience

Years of Experience : 5 years of experience in medical or behavioral health billing

Additional Skills : Knowledge and proficiency in using billing software. Knowledge of insurance authorization process. Computer knowledge and literacy. Ability to accept direction and supervision. Analytical skills are desirable. Intermediate experience using Excel.

Neighborhood Service Organization is an equal opportunity employer and values diversity in its workforce. We encourage applications from all qualified individuals, including those with diverse backgrounds and those with disabilities.