Prior Authorization Billing Specialist

Job Description

Job Description

The Prior Authorization Specialist at Team Recovery is responsible for managing the pre-authorization processes to ensure the timely submission of requests to insurance companies for healthcare services provided. They will work closely with healthcare providers, insurance companies, and other stakeholders to ensure compliance with regulatory standards and maximize revenue collection in a timely and efficient manner.

Education Requirements:

• Required: High School Diploma or GED.
• Preferred: Associates or Bachelors degree in Healthcare Administration from an accredited college or university.

Experience Requirements:

• Preferred: Minimum of 3+ years of experience and a strong understanding of the credentialing, prior-authorization, and insurance reimbursement processes.
• Preferred: Experience in the Behavioral Health and SUD treatment field.

Job Responsibilities:

• Obtain prior authorizations from insurance companies for behavioral health and addiction recovery services and medications.
• Review client medical records and treatment plans to determine the medical necessity of requested services.
• Submit prior authorization requests to insurance companies and follow up on the status of pending requests.
• Communicate with healthcare providers, insurance companies, and clients to gather necessary information for prior authorizations.
• Ensure compliance with insurance requirements and guidelines for prior authorizations.
• Maintain accurate records of prior authorization requests and approvals.
• Stay up-to-date on insurance policies and guidelines related to addiction recovery services.
• Collaborate with the clinical team and billing department to facilitate the prior authorization process.

Knowledge Requirements:

• Ability to read and interpret written information; write clearly and informatively; edits work for spelling and grammar. Ability to speak clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; and participates in meetings.

• Must have excellent problem-solving and decision-making skills with the ability to work under pressure, manage conflict, and appropriately prioritize responsibilities.

• Working knowledge of Microsoft Office Suite (Word, Excel, Powerpoint, OneNote, Calendar, Outlook, and Teams).

• Working knowledge of Google Workplace (Docs, Sheets, Slides, Forms, Gmail, Chat, Spaces, Keep, Tasks, Calendar, and Meet).

• Ability to manage multiple tasks/projects, and deadlines simultaneously and to identify and resolve exceptions and to interpret data, proficient in data entry

• Proficiency in using billing software and Electronic Medical Records (EMR) systems.

• In-depth knowledge of Credentialing systems and procedures, including MITS, PNM, and more.

• In-depth knowledge of Medical Billing and Coding systems and procedures, including CPT, ICD-10, HCPCS coding, and more.

• Knowledge of submitting and following up on Prior-Authorizations.

• Proficiency with insurance guidelines, including Medicaid and private insurance carriers.

• Understanding of HIPAA regulations and ability to maintain confidentiality of patient information.

• Knowledge of Federal, State and Municipal laws and/or regulations that regulate the treatment of alcoholism and drug addiction, including:
  • Confidentiality
  • Patient Rights
  • Professional Code of Ethics
  • Discrimination
• Knowledge of airborne and blood borne pathogens (TB, HIV, AIDS, HB) and risk reduction methodologies and the use of universal precautions.
• Flexibility to adapt to schedule changes and assumption of responsibilities not delineated in the job description which are related to work as a member of an addiction treatment team.

**Ability to pass a pre-employment background check and drug screen (required).