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Authorization Specialist

Company: Crossroads Treatment Centers
Location: Greenville
Posted on: May 3, 2021

Job Description:

COMPANY DESCRIPTION:

Crossroads Treatment Centers was founded on May 5, 2005 to serve a patient population battling with opioid addiction. Since its founding in 2005, we have been a physician led healthcare organization. The company has grown rapidly and now includes 90+ treatment centers in 10 states. Each member of the Crossroads team specializes in an area that supports the recovery of over 26,000 patients, monthly. Crossroads' clinical staff includes physicians, pharmacists, counselors, nurses, and other service coordinators. Along with medication management, our staff works closely with each patient to create an individualized treatment plan aimed at building recovery and relapse prevention skills.


ROLE AND RESPONSIBILITIES

  • Responsible for the accurate and timely processing of verification of benefits and eligibility requests.
  • 70% Review patient accounts flagged for prior authorization request needs. Will process authorizations by phone, fax, and portals for multiple payer types and various state Medicaids.
  • 20% Other duties will be obtaining retro authorizations, appeals, and reviewing medical charts for medical necessity.
  • 5% Researches and processes eligibility requests according to business regulation, internal standards and processing guidelines. Verifies the need for prior authorizations or the need for retro billing.
  • 5% Coordinates with internal departments to work changes in payor billing guidelines, updating the patient identification, other health insurance, provider identification and other files as necessary.

REQUIREMENTS

  • Responsible for processing authorizations. Receiving approval for all services Crossroads provide.
  • Research and appealing denied authorizations.
  • Must possess a good working knowledge of payer eligibility guidelines, payer portals, and clearinghouses to ensure a complete verification of benefits.
  • Responsible for tracking and organizing status of authorizations, inputting authorization numbers into the EMR, and scanning proof of authorization obtained into patients' charts.
  • Responsible for all missing authorization related denials to identify trends to improve reimbursement rates
  • Responsible to work all authorization requests within a 24/48-hour turnaround time from receipt.
  • Understands and adheres to state and federal regulations and system policies regarding compliance, integrity and ethical billing practices.
  • Must complete annual Relias training.
  • Other duties as assigned

EXPERIENCE

  • Must have had at least 4 years electronic insurance verification, real time eligibility, and/or billing experience in a hospital and/or physician office setting.
  • General Knowledge of HCPCS, CPT-4 and ICD9-10 coding and/or medical terminology.
  • Familiar with multiple payer requirements and regulations for utilizing benefits

REQUIRED SKILLS AND ABILITIES:

  • Strong analytical, organizational skills.
  • Strong oral and written communication skills.
  • Good judgment skills.
  • Basic business skills.
  • Solid Microsoft Office skills required.
  • Good communication skills and the ability to courteously interact with multiple departments

Keywords: Crossroads Treatment Centers, Greenville , Authorization Specialist, Other , Greenville, South Carolina

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