Authorization Specialist

: Change Lives With Recovery Innovations! Our Mission is to empower people on their journey to recovery, helping them achieve their goals, rediscover meaning and purpose in life, and reconnect with themselves and their communities. Our Vision is to revolutionize healthcare by pioneering innovative solutions that go beyond behavioral health, empowering people to thrive in the communities where they live, work, and play. Join a groundbreaking team at the forefront of Peer-Powered Support , empowering individuals on their journey through mental health and substance use challenges! Be part of something bigger—together, we can change lives and create lasting hope! Position: Authorization Specialist Job Type: Full-Time; Non-Exempt Shift Details: Rotating 4 ten-hour days, works 1 weekend a month. Training hours will be Monday - Friday 8:00am to 5:00pm Work Location: Remote Salary/Hourly Wage: $18.00 - $24.00/hour Specialties / Licenses or Certifications:

• Knowledge of the 6 MCOs in Louisiana
• Insurance verification and authorization experience required
• Experience submitting authorizations via insurance portal
• Experience working for crisis facilities

Summary of Job: The Authorization Specialist position is responsible for reviewing clinical documentation per HCPCS, CPT, and ICD-10 codes, initiating, submitting, and follow up on authorizations per payer portals, and by faxing requests. Complete data entry and administrative support functions for the organization's Billing Department. Your Responsibilities

• Verify insurance coverage and eligibility
• Knowledge of CPT, HCPCS, and ICD-10 codes.
• Review procedure orders and documentation to determine necessity of prior authorization.
• Run account detail report, unbilled report, and any other claims detail report for proper follow up as needed.
• Provide feedback to departments, sites, and payers on project status.
• Strong written and communication skills with providers, team members and clients.
• Detailed documentation of authorization numbers and process for each prior authorization.
• Maintain accurate patient medical records.
• Make status calls to insurance companies and utilize payer portals to follow on submitted authorization for reimbursement.
• Identify, analyze, report on trends and analysis of all payer issues and report it to the Revenue Cycle Manager.
• Research authorization denial reasons per payers or by contacting the funders to maximize claim reimbursement.
• Follow company processes related to submission of corrected authorizations and appeals.
• Maintain tracking sheet of pending/resolved issues and historical payer issues.
• Understands and adheres to Recovery Innovations compliance standards as they appear in the Code of Conduct and Conflict of Interest Policies.
• Keeps abreast of all federal and state regulations and laws and all Recovery Innovations policies as they presently exist and as they change or are modified.
• Travel as needed
• Performs other related duties assigned.

Your well-being and success are our priority at RI—explore our benefits and discover how we invest in YOU every step of the way! As an innovative leader in behavioral health care, we are committed to supporting our teams through a comprehensive benefits package. This includes competitive health, dental, and vision insurance, as well as access to mental health resources and wellness programs. We offer a strong retirement plan with company matching and generous paid time off to support work-life balance. In addition, we provide ongoing opportunities for professional development and training to help you advance in your career. We value the contributions of our team members and are dedicated to fostering a supportive, inclusive environment where you can thrive both personally and professionally. Job Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

• Organized and detail oriented.
• Excellent time management skills
• High school diploma or equivalent.
• 5+ years of authorization experience required.
• Working knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
• Detailed oriented, reliable, and able to multi-task in a fast-paced, high-volume work environment.
• Intermediate to Advanced proficiency in Microsoft Excel.
• Must have a valid driver license and be 18 years of age
• Understands and adheres to RI International compliance standards as they appear in the Code of Conduct and Conflict of Interest Policies.
• Ability to maintain a high level of confidentiality (HIPAA guidelines and regulations) and professionalism.
• We are a Second-Chance Employer
  • Must be able to pass a seven-year background check.
  • Must be able to pass substance abuse testing and/or tuberculous testing (if applicable).
  • Must be able to pass education verification check.
  • Must be able to pass three-year motor vehicle report and meet minimum eligibility requirements criteria of insurance carrier (if driving is required for this position).

Recovery Innovations is committed to providing equal employment opportunities to all individuals. Our hiring practices are based on merit, qualifications, and abilities. We do not discriminate against any employee or applicant on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected by law. We strive to create a workplace where every employee feels valued and respected. Recovery Innovations is a second chance employer and we evaluate all qualified applicants fairly, including those with criminal histories, in accordance with legal and funder requirements. If you need assistance and/or reasonable accommodation due to a disability during the application or the recruiting process, please send a request via the Accommodation request form. Benefits/perks listed above may vary depending on the nature of your employment with Recovery Innovations. The wage range for this role considers the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. At Recovery Innovations compensation decisions are dependent on the facts and circumstances of each case.