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Pre-Authorization Coordinator

Company: New Season
Location: Maitland
Posted on: October 13, 2021

Job Description:

For over 30 years, New Season Treatment Centers have been a leading national health care service provider of outpatient treatment centers that specialize in providing safe, quality and best in class care for individuals living with Opioid Use Disorder ("OUD").

Operating in over 70 treatment centers in multiple states, our team members are engaged in medication-assisted treatment, counseling, support, and care management of individuals living with OUD. We treat the whole person and, in so doing, address the underlying causes of OUD in an effort to provide a continuum of care that not only addresses treatment needs but supports the patient on their journey to recovery.

 

PRE-AUTHORIZATION COORDINATOR

Job Description

New Season


 

Reports to: Director of Patients Accounts

Job Code: 350

Department: Revenue Cycle

FLSA: Non-Exempt

Direct Reports: 0


Job Summary:

This position is responsible for obtaining the appropriate authorization, referrals, and care coordination from the insurance companies and third-party payers. This also includes providing detailed and timely communication to both payers and clinical partners in order to facilitate compliance of benefits and care.


Essential Functions:

  • Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services.
  • Responsible for pre-certification, authorization, and referral requirements for services.
  • Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate the authorization process.
  • Facilitate submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policy and procedures.
  • Ensures timely and accurate insurance authorizations are in place prior to services being rendered.
  • Prioritize workload to ensure the most urgent cases are handled in a timely manner.
  • Keep open lines of communication with the Clinic Operation Team to ensure individualized goals are met.
  • Adheres to the service policy and principles of CMG/ New Seasons.
  • Other duties as assigned.

Supervisory Responsibilities:

(This position will supervise non-exempt staff in support roles performing duties described in "Essential Functions".)

None


Essential Qualifications:

(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the competencies (minimum knowledge, skill, and ability) required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions).

 

Education/Licensure/Certification: High School Diploma or GED.


Required Knowledge: Understanding of the various types of insurances. Knowledge of computer and internet applications and data management as well as an understanding of reporting requirements. Proficiency with numbers. Data entry experience. Experience working with Zirmed program is a plus. Computer skills, and proficiency with Microsoft Office and Google. Excellent internal & external customer service and communication skills. Understanding of insurance and insurance related coding to support claim processing. Understanding of government payers including Share of Cost.


Experience Required: This position requires 2 or more years of experience in billing/pre-authorization or insurance verification. Prior experience in a business office position. Strong customer service background preferred.


Skill and Ability: Ability to work with both technical and administrative personnel. Strong organizational skills with a keen ability to prioritize and multitask. Ability to adhere to and meet deadlines. Experience in handling sensitive, confidential information. Excellent communicator (oral and written) including the desire to ask questions and learn from co-workers. Strong Excel and other MS Office product skills. Strong administrative and data entry skills. Ability to raise issues proactively and in a timely manner. Excellent Customer service skills.




Physical Demands/Work Environment:

(The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

 

Finger Dexterity: Use primarily for writing, operating calculator, telephone, keyboard and other office equipment.

 

Talking: To convey detailed or important instructions to employees, patients and applicants.

 

Hearing: Ability to hear normal conversations and receive ordinary information.

 

Vision: Average, ordinary, visual acuity necessary to observe and work on a computer. Clear vision at 20 inches or less and distant vision at 20 feet or more.

 

Physical Strength: Sedentary work; sitting most of the time. Exerts up to 10 pounds of force occasionally.


 

Working Conditions:

(The working conditions described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

 

  • Ability to operate in an open work area with moderate everyday noise.

 

Core Competencies:

 

  • Approachability
  • Time Management
  • Communication (Oral)
  • Ethics/Values/Integrity
  • Influencing/Persuading
  • Listening
  • Problem Solving
  • Strategic Planning/Thinking

Mental Activities:

(The mental activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

 

Reasoning Ability: Ability to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. Ability to maintain confidentiality.


Mathematics Ability: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumferences and volume.

 

Language Ability: Ability to read, analyze and interpret Explanation of Benefits, Insurance eligibility, Insurance Verification.
40CMG Corporate

Keywords: New Season, Orlando , Pre-Authorization Coordinator, Other , Maitland, Florida

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