Authorization Specialist

About New England Life Care (NELC)New England Life Care (NELC) is one of the fastest growing home infusion therapy companies in New England and is the region's only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care. New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you're energized by this opportunity, but your experience doesn't support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!Remote Authorization Specialist PositionThe normal schedule is Monday – Friday from 8:30am to 5:00pm.We are only hiring for this remote role in the following states: Maine, Massachusetts, New Hampshire, Maryland, North Carolina, Connecticut, and Florida.Job SummaryThe 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 LaddersNELC's reimbursement department offers career ladders to Authorization Specialists. Candidates who achieve excellent performance in their job duties, who demonstrate a commitment to personal development, participation in department and company strategic programs and projects, who develop superior working relationships inside and outside the department and who show a commitment to the success of the department are eligible for promotion to the following positions: 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.BenefitsRemote positionRoom for growth and potential for advancementHealth insuranceDental insuranceVision insuranceGenerous employer-matched 403b savings programCompany paid: Life insurance, Short- and long-term disability insurancePaid time offAnd much more!ResponsibilitiesAchieve performance appraisals with "meets expectations" or betterMaintain a good record of attendance and punctualityNo Performance management deficiencies in the periodDemonstrate independence and competence to follow Authorization Request process for all payersDemonstrate independence and competence to follow the Re-Authorization processDemonstrate independence and competence to follow the Specialty processDemonstrate independence and competence on all MOA's and therapiesDemonstrate independence and competence and ability to Authorize all services, document and communicate accurately on all changes of service, in CPR+ and to appropriate departmentsDemonstrate independence and competence and ability to work through a TO DO without the need for extended timeframesDemonstrates the ability to work within a team and independently with confident communication skills and exceptional customer service skillsCompletes three continuing education programs in the period specifically related to professional development, LEAN and/or leadership developmentEducationHigh School Diploma, or equivalent requiredMinimum of 2 years authorization, reimbursement or claims processing experience requiredRequirementsPractical experience with medical terminology; CPT, ICD-9 and HCPC coding preferredPractical experience with Medicare, Medicaid and third-party payor contracts preferredKnowledge of HIPAA Privacy and Security requirements preferredSkillsExcellent organizational skills requiredBasic accounting transaction/analyst skills requiredDemonstrated ability to identify research and solve problems requiredAbility to work independently as well as part of a team requiredPractical experience with Microsoft computer systems and applications, to include Word & ExcelIt is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.EOEThe normal schedule is Monday – Friday from 8:30am to 5:00pm.J-18808-Ljbffr