[Hiring] Authorization Specialist @New England Life Care

Role Description

The Remote Authorization Specialist is responsible for obtaining and maintaining prior authorization status for NELC patient medications/therapies. The authorization specialist works closely with the clinical review department to obtain documentation needed to complete the authorization process. The authorization specialist also obtains needed documentation to support the billing department in meeting payer requirements for patient accounts.

Career Ladders

• Authorization Specialist – Represents an entry-level position into the department. Candidates who meet defined goals, objectives, and accomplishments can generally expect to be promoted in 2-3 years to:
• Senior Authorization Specialist – Candidates who meet defined goals, objectives, and accomplishments and who demonstrate engagement and ownership of departmental and organization activities would generally expect to be promoted in 4-5 years to:
• Lead Authorization Specialist – Candidates who are part of the department leadership team and who have responsibility for advanced departmental, company, and member hospital engagement.

Responsibilities

• Achieve performance appraisals with "meets expectations" or better.
• Maintain a good record of attendance and punctuality.
• No performance management deficiencies in the period.
• Demonstrate independence and competence to follow Authorization Request process for all payers.
• Demonstrate independence and competence to follow the Re-Authorization process.
• Demonstrate independence and competence to follow the Specialty process.
• Demonstrate independence and competence on all MOA's and therapies.
• Demonstrate independence and competence and ability to authorize all services, document and communicate accurately on all changes of service, in CPR+ and to appropriate departments.
• Demonstrate independence and competence and ability to work through a TO DO without the need for extended timeframes.
• Demonstrates the ability to work within a team and independently with confident communication skills and exceptional customer service skills.
• Completes three continuing education programs in the period specifically related to professional development, LEAN and/or leadership development.

Qualifications

• High School Diploma, or equivalent required.
• Minimum of 2 years authorization, reimbursement or claims processing experience required.
• Practical experience with medical terminology; CPT, ICD-9 and HCPC coding preferred.
• Practical experience with Medicare, Medicaid and third-party payor contracts preferred.
• Knowledge of HIPAA Privacy and Security requirements preferred.

Skills

• Excellent organizational skills required.
• Basic accounting transaction/analyst skills required.
• Demonstrated ability to identify, research, and solve problems required.
• Ability to work independently as well as part of a team required.
• Practical experience with Microsoft computer systems and applications, to include Word & Excel.

Benefits

• Remote position.
• Room for growth and potential for advancement.
• Health insurance.
• Dental insurance.
• Vision insurance.
• Generous employer-matched 403b savings program.
• Company paid: Life insurance, Short- and long-term disability insurance.
• Paid time off.
• And much more!