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 BAYADA’s mission, services, people, organization, policies and procedures.


• Provide backup support for routine support questions.


• Meet metrics that support BAYADA’s 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.