Authorization Specialist

Recovery Innovations is the leader in Peer-Powered Support to those in crisis for mental health and substance use.Our Mission is to empower people to recover, succeed in accomplishing their goals, find meaning and purpose in life, and reconnect with themselves and others.Our Vision is to activate the next generation of frame-breaking healthcare innovation to support people beyond their behavioral health needs and succeed in the community where they live, work, and play.Job TypeFull-Time: HourlyShiftDayShift HoursSunday - Wednesday - 8:00am - 6:30pmWork SettingOn-SiteSalaryHourly Wage$18 - $24HourOur PositionThe 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 Rewards Nine (9) company-paid Holidays (Full-Time Only) Paid-Time Off; Accrued bi-weekly (Full-Time Only) Company-Paid group life insurance (Full-Time Only) Medical, Dental, and Vision plans start the 1st of the month following your start date (Full-Time Only) Retirement Plans with Company match including 401k and Roth Employee Assistance Programs (Full-Time Only)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 pendingresolved 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.Our RequirementsTo 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, andor 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 andor 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 an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, family or medical care leave, gender identity or expression, genetic information, marital status, medical condition, national origin, physical or mental disability, political affiliation, protected veteran status, race, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable laws, regulations, and ordinances. Recovery Innovations is a second chance employer and we consider qualified applicants regardless of criminal histories, consistent with legal requirements. If you need assistance andor reasonable accommodation due to a disability during the application or the recruiting process, please send a request via the Accommodation request form.Benefitsperks 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, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.Pay Range: $18 - $24 per hour

Created: 2025-01-10