Authorization Associate

POSITION SUMMARY:

The Associate Authorization is a position responsible for ensuring that patient care services are ready to bill accurately and in a timely manner. The primary responsibility of the role is to obtain authorization for care from insurance carriers and provide denial support. This position will serve as a liaison between the service office providers insurance carriers and revenue cycle management functions. A high level of customer service and support is required to obtain insurance authorization and effectively communicate clients coverage.

MINIMUM QUALIFICATIONS:

• Exemplifies characteristics of The BAYADA Way: compassion excellence and reliability.
• Four (4) year college degree.
• Prior healthcare and/or home care experience preferred.
• One (1) year of relevant work experience obtaining authorizations and verifying eligibility is preferred.
• Demonstrated record of strong interpersonal skills and building relationships
• Self-motivated flexible and versatile.
• Strong customer service skills.
• Demonstrated record of goal achievement.
• Basic PC skills required to perform job functions.
• Proven ability to multitask and manage competing priorities.
• Ability to sort and arrange information and files in an appropriate manner.

PRIMARY RESPONSIBILITIES:

• Demonstrate and communicate the core values of BAYADA and The BAYADA Way.
• Develop working knowledge of BAYADAs mission services people organization policies and procedures.
• Provide backup support for routine support questions.
• Meet metrics that support BAYADAs goals and objectives and measure effectiveness.
• Prepare reports and presentations using Microsoft Office (Word Excel PowerPoint etc.).
• Support annual audits and compliance reviews as needed.
• Learn various aspects of the organization through technology training hands-on learning cross-training and site visits.
• Support authorization and eligibility workflow within appropriate system/s.
• Communicate effectively and maintain positive working relationships with insurance companies referral sources service offices etc.
• Perform related duties or as required or requested by supervisor.

OTHER RESPONSIBILITIES:

• Manage a caseload and provide customer support for dedicated service offices.
• Perform utilization management (review plan of care and utilization requests) to ensure proper number of days are requested.
• Respond timely to requests and/or escalate review of denied requests.
• Communicate with insurance companies via portals phone or other third-party systems to request authorization.
• Support supplies and referral management.
• Provide any support to revenue cycle teams regarding authorization discrepancies or payor requirement changes.
• Submit appeals to insurance companies.
• Obtain denial letters from primary insurance companies when a secondary carrier is being billed yearly or as needed.
• Review and interpret authorization for services rendered to mitigate claim/EDI errors and denials.