Authorization Specialist

Hours: Monday-Friday, 8:30 a.m. - 4:30 p.m.

Join our Billing Department as an Authorization Specialist. This position is responsible for all aspects of the prior authorization process from insurance verification to authorization to include collecting all necessary documentation, contacting client and/or clinical for additional information and completion of the insurance verifications and required prior authorization or Blanket Denial Letter in order to proceed with treatment.

• Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt of the services.
• Successfully works with payers via electronic/telephonic, email and/or fax communications.
• Responsible for verification and investigation of pre-certification, and authorization.
• Coordinates and supplies information to the payer, including medical information and/or a letter of medical necessity for determination of benefits.
• Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
• Communicates with patients, clinical partners, and others as necessary to facilitate verification of insurance and authorization process.
• Responsible for updating and maintaining insurance and authorization information within Carelogic. Being sure to keep updated copies of Insurance cards scanned for each insurance, as well as paper authorizations and authorization packets scanned into Carelogic.
• Creates and supports an environment which fosters teamwork, cooperation and respect.
• Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner.
• Completes accurate, detailed and professional documentation of workflow for each client in designated location. Being sure to include Reference numbers for all insurance correspondence as well as dates for each note.
• Responsible for obtaining BDL-Blanket Denial Letters for any clients whom you are not able to obtain Authorization for.
• Maintaining BDL's and the BDL Spreadsheet, requesting new BDL's prior to expiration of current BDL so there is no lapse in Authorization.
• Running, reviewing and maintaining Bi-Weekly EVS-Eligibility Verification System Reports for all assigned programs. Updating and re-verifying insurance as necessary.
• Identify and report trends and prior authorization issues relating to billing and reimbursement.

• 2+ years of experience working with prior authorizations and insurance verifications.
• Knowledge of online Insurance Verification Systems and Medical Authorization request/process.
• Clinical knowledge in Behavioral Health is preferred.
• Complete working knowledge of the Microsoft Windows environment and Microsoft Office product with emphasis on the Excel module is required
• Valid driver's license and good driving record
• Eligibility for State Police Criminal Record Check and Child Abuse History Clearance
• FBI clearance required for individuals who do not meet PA residency requirements

Healthcare
Highmark Medical and Mental Health
Affordable Telemedicine only option
Free Delta Dental Coverage
Free Davis Vision Coverage
Short & Long-Term Disability Insurance
Healthcare Flexible Spending Account
Financial Well-being
401K and 403B Retirement Savings options
Employee Referral Bonus program
Student Loan Forgiveness
College Scholarship & Tuition Discounts
Employee Discounts
Life & Family Support
Free Life Insurance
Dependent Care Flexible Spending Account
LifeSolutions Employee Assistance Program
Erie Campus*- discounted on-site weekday childcare
Employee discounts for select events and services

The Barber National Institute is a non-profit committed to its mission of providing the highest quality services for children and adults with autism, intellectual disabilities, or behavioral health challenges and their families. Since our founding in 1952, we have evolved into a multi-faceted organization serving more than 6,200 individuals annually with a wide range of educational, vocational, residential, and behavioral health programs.

Qualified applicants must meet eligibility for PA Child Abuse History and Criminal Record Check.We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, ancestry, age, sexual orientation, protected veteran status, disability, or any other legally protected status. If you need accommodation to apply, please contact HR. EOE