Insurance Authorization Senior Associate

Remote role but must be willing to work 8:30-5pm Eastern time.

POSITION SUMMARY: 

The Senior Associate, Authorization is a position responsible for ensuring that patient care services are ready to bill accurately in a timely manner. The primary responsibility of the role is to obtain authorization for care from insurance carriers and provide denial support. This position will serve as a liaison between the service office providers, insurance carriers, and revenue cycle management functions. A high level of customer service and support is required to obtain insurance authorization and effectively communicate clients’ coverage. The Senior Associate will also provide mentorship and educational support to team members.

MINIMUM QUALIFICATIONS:

• Exemplifies characteristics of The BAYADA Way: compassion, excellence and reliability.
• Four (4) year college degree.
• Two (2) to four (4) years of relevant work experience with growing responsibilities.
• Prior healthcare and/or home care experience preferred.
• Proficient knowledge of insurance benefits and contracts.
• Demonstrated record of strong interpersonal skills and building relationships.
• Ability to work independently, motivate, be self-motivated, and flexible.
• Strong customer service skills and demonstrated commitment to quality in all customer encounters.
• Demonstrated record of meeting and exceeding goal achievements.
• Proven ability to multitask and manage competing priorities.
• Good analytical skills with the ability to problem solve and exhibit good judgement.
• Proficient PC skills and technical ability to navigate required systems to perform job duties.

PRIMARY RESPONSIBILITIES:

• Demonstrate and communicate the core values of BAYADA and The BAYADA Way.
• Develop working knowledge of BAYADA’s mission, services, people, organization, policies and procedures.
• Provide backup support for routine and escalated support questions.
• Consistently attains and/or exceeds metrics that support BAYADA’s goals and objectives and measure effectiveness.
• Prepare reports and presentations using Microsoft Office (Word, Excel, PowerPoint etc.).
• Leads annual audits and compliance reviews in partnership with management, as needed.
• Actively seeks to learn various aspects of the organization and healthcare through internal and external educational opportunities.
• Drives authorization and eligibility workflow within appropriate system/s (initial, reauthorization, EVV compliance).
• Excel at building trusting relationships and collaborates with immediate team members and external teams.
• Manage the creation of user documentation, process diagrams and training materials.
• Demonstrate solid performance or exceed performance standards in key job dimensions/attributes as defined on the Performance Appraisal for Office Staff.
• Perform related duties, or as required or requested by supervisor.

AUTHORIZATION RESPONSIBILITIES:

• Manage a caseload and provide customer support for dedicated service offices.
• Perform utilization management (review plan of care and utilization requests) to ensure proper number of days are requested.
• Respond timely to requests and/or escalate review of denied requests.
• Communicate with insurance companies via portals, phone or other third-party systems to request support supplies and referral management.
• Provide any support to revenue cycle teams regarding authorization discrepancies or payor requirement.
• Submit appeals to insurance companies.
• Review and interpret authorization for services rendered to mitigate claim/EDI errors and denials.
• Obtain denial letters from primary insurance companies when a secondary carrier is being billed yearly or as needed.

OTHER RESPONSIBILITIES:

• Provide additional support and education to service offices on an as needed basis.
• Progressively assume additional responsibilities beyond general scope of work.
• Provide expertise, guidance, and mentorship to associate level team members.
• Engage in ongoing dialogue with manager and/or director about the effectiveness of systems and performance improvement.