Reauthorization Specialist

Reauthorization Specialist

The Reauthorization Specialist is responsible for managing all aspects of reauthorizations for client care. This includes re-verifying client eligibility, monitor insurance lifetime caps and prior authorization periods.

Schedule: Remote Mon-Fri 40 hours per week.

We offer our team the best:

• Medical, Dental and Vision Benefits
• Continued Education
• PTO Plan
• Retirement Planning
• Life Insurance
• Employee discounts

Process Intake, Reauthorization and Payer Transfers:

• Process new intakes and reauthorization by reviewing referrals.
• Ensure all services are authorized within required time frame to prevent laps in care.
• Monitor authorization start and end date to proactively manage renewals and prevent expirations.
• Follow up on pending authorization and communicate updates to the branch.

Documentation and Data Entry:

• Accurately enter and update authorization detail in the system, ensuring all information align with payer approvals.
• Maintain complete, compliant, and well-organized patient records.
• Review documentation for accuracy and consistency prior to submission or scanning.
• Scan, upload and index authorization documents into the appropriate system and a timely manner.

Payor Transfer and Coordination:

• Handle payer transfers, ensuring authorization are updated and aligned with the new payer requirements.
• Verify coverage details and authorization rules during payer change to maintain uninterrupted services.

Expired Reports and Requesting Authorization:

• Manage expired authorization report, identify discrepancies and take corrective action.
• Track and resolve authorization issues that may effect billing, scheduling, or services.
• Communicate with branches regarding or pending authorization and require next step.

Branch Support and Communications:

• Providing guidance and support related to authorization, documents and intake process.
• Respond to branch inquiries promptly and collaborate to resolve authorization or documents issues.
• Communication clearly and professionally via email and internal systems keep all parties informed.

Quality Assurance and Compliance:

• Ensure all process comply with payor guidelines, company policies and regulatory standards.
• Identify errors or discrepancies and take corrective action to maintain data integrity.
• Support workflow efficiency by proactively addressing issues before they impact patient care or operations.

Key Strengths/Requirements in the Role:

• Strong attention to detail accuracy in documents and data entry.
• Effective communication and collaborations with branch teams.
• Ability to manage high volume of authorization and deadlines.
• Proactive problems-solving to prevent service disruptions
• High school diploma or GED equivalent, some college preferred
• 1-2 years of recent experience working in a health care setting and insurance authorizations
• Excellent written and oral communication skills
• Excellent customer service skills
• Must be computer literate and possesses knowledge of computer software, Microsoft Excel (advance skills preferred), internet, Word and Outlook
• Dependable, conscientious and reliable
• Ability to analyze and interpret situations to complete tasks or duties assigned