Authorization Specialist

Job Description

Job Description

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!

New England Life Care currently has a Remote Authorization Specialist position available. The normal schedule is Monday – Friday from 8:30am to 5:00pm .

The ideal candidate for this role will have at least three years of authorization or billing experience.

**Only hiring for this remote role in the following states: Maine, Massachusetts, New Hampshire, Maryland, North Carolina, Connecticut, and Florida**

Job Summary:

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: NELC’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.

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!

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.

Education:

• 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

''It 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.''

EOE