Monday-Friday 8:30 a.m.-5pm No Weekends w/Holiday Rotations
Position Purpose:
The Authorization Specialist is responsible and accountable for the processing of all THAH authorization documentation meeting HCFA/MCC/JCAHO regulations and guidelines. Primary responsibilities include processing all frontend documentation needed to meet third party payer authorization deadlines assuring accurate billing. In addition, monitors all accounts for ongoing authorization needs to ensure optimal reimbursement and compliance per agency policy. This position works closely with the THAH insurance team and THAH Collection analysts in the tracking of authorizations and resolution of problematic billing issues. Monitors pending authorizations report and collaborates with both the clinical and revenue cycle team to review and resolve pending claims to ensure timely payment. Duties may be accomplished in a remote work environment.
What You Will Do:
Prepares and enters data into the appropriate software assuring the accuracy of the regulated client account following all regulations placed on the homecare agency. Ensures that input of information is accurate, and authorization is received timely for the submission of claims. Responds to all system issues by preparing documentation for the resolution center. Timely follow up on pending authorizations to ensure payment of claims.
Generates all authorization documentation needed to bill in a timely manner assuring industry standards are met. Monitors and processes the Subsequent Authorizations workflow and reports daily to assure timely and clean billing.
Utilizing the CQI Process Improvement technique, responsible for implementing and monitoring changes to processes to ensure continued integrity of client accounts. Collaborates with the Intake Department to identify processes for improvement ensuring the accuracy of the authorization process.
Provides statistical feedback regarding the status of unbilled claims due to authorizations to THAH Revenue team on a weekly basis or as defined by policy.
Interfaces with THAH to resolve problems related to the processing of bills/claims. Investigates client accounts and provides any additional documentation required.
Seeks assistance of Clinical Team Leaders and/or Revenue Cycle Leaders with clinical data entry and/or billing problems.
Coordinates the flow of billing related paperwork between the branch and THAH Service Center. Works with the branch and THAH colleagues to identify areas of improvement related to authorization workflow. Actively participates in all billing conference calls between the agency and THAH.
Acts independently and responsibly to perform duties on a consistent basis and in a timely manner.
Coordinates tracking system to monitor unbilled claims due to authorizations and utilizes appropriate monitoring reports available.
Acts as liaison between physician offices, THAH Service Center and the agency to assure timely billing with appropriate documentation.
Ensures that services provided support continuous quality improvement, customer-oriented focus, and quality client care outcomes.
The duties and responsibilities described are not a comprehensive list and additional tasks may be assigned from time to time, as the scope of the job may change as necessitated by business demands.
Benefits:
Day 1 Benefits - Health, dental and vision insurance
Work Today Get Paid Tomorrow
Employee Referral Reward Program
Short and long-term disability
Tuition Reimbursement
Paid CEUs
403b
Generous paid time off
Comprehensive orientation
Minimum Qualifications:
The incumbent can articulate and demonstrate a commitment to the mission, vision, and values of Trinity Health and to inspire active support of these in others.
The preferred candidate will have a high school diploma or GED.
College business courses or an associate degree is preferred, or four to six years of experience in a medical billing office setting with a concentration on authorizations.
A strong knowledge of general business office functions, strong analytical and organizational skills and microcomputer usage is required.
Incumbent must possess the following: ability to meet strict deadlines with high level of accuracy, ability to prioritize multiple tasks in highly automated setting and possess strong interpersonal skills.
Ability to consistently demonstrate commitment to the mission and Organizational Code of Ethics and adhere to the Compliance.
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Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.