Job Description

Upstream Rehabilitation, is looking for an Clinical Authorization Specialist- Workers Compensation (REMOTE WA time zone) to join our team

  Position Summary:
The Authorization Specialist is responsible for working with insurance companies and relevant third parties regarding verification of benefits (VoB) and obtaining required authorization for treatment. The Authorization Specialist ensures accurate selection of insurance plan, documentation of benefits coverage, and submission of necessary pre-authorization and/or re-authorization to ensure no delay in reimbursement of treatment. This position is responsible for supporting the mission, vision, and values of Upstream Rehabilitation. This position supervises direct and indirect reports.
Responsibilities:
• Reviews patient electronic health record and verification of benefits completed by 3rd party (Guidehouse) for all patients.
• Communicates with payors to obtain any clarifications on the verification of benefits.
• Maintains positive payor relationships.
• Works with payors to obtain prior- and re-authorizations as required by the patient plan of care and payor.
• Handles documents and records related to patient insurance benefits and required authorizations and submits to payors accordingly.
• Manages requests to ensure prior authorizations are submitted within timeline guidelines.
• Follows up with payors to check the status of previously submitted authorizations.
• Processes authorization appeals for the appropriate patients.
• Works with back-end revenue cycle to understand and address authorization issues that may lead to downstream denials or write-offs.
• Reverifies insurance and authorization if needed for the crossover process (EOY insurance changes).
• Handles patients that have a change in payor during their plan of care as indicated by the payor overlap form submitted by an Office Coordinator.
• Maintains a working understanding of insurance benefits and seeks assistance as necessary.
• Determines and documents the amount to be collected from each patient visit (copay, co-insurance, payment towards deductibles).
• Monitors reports and dashboards related to patient benefits / authorizations and works with clinic and business office teams to improve results.
• Demonstrates communication skills that aligns with Mission, Vision and Values.
• Supports organizational changes and required clinic changes.
• Other duties as assigned.

Location:
Remote

Fulltime positions include:

• Annual paid Charity Day to give back to a cause meaningful to you
• Medical, Dental, Vision, Life, Short-Term and Long-Term Disability Insurance
• 3-week Paid Time Off plus paid holidays
• 401K + company match

Follow @Lifeatupstream on Instagram, and check out our LinkedIn company page to learn more about what it’s like to be part of the #upstreamfamily.

CLICK HERE TO LEARN EVEN MORE ABOUT UPSTREAM