Address
SalaryValera Health is a leading tele-mental health service provider, utilizing cutting-edge digital technology and carefully cultivated teams to deliver top-tier, behavioral healthcare. We believe that mental health care should be simple, accessible, and affordable.
Why Valera:
Our Purpose: to provide compassionate mental health care to those who need it the most, when they need it the most.
Mission Driven: We know that behavioral healthcare isn't one-size-fits-all, and we've tailored our complete care model to meet the needs of the individual. We believe that no one should be excluded from receiving the care they need, and our diverse team reflects the change we bring to the space.
Culture: At the core of our culture lies a profound commitment to fostering a spirit of teamwork, dedication to continuous learning, a devotion to integrity, and a pursuit of delivering the highest quality mental healthcare services. Our ethos is rooted in nurturing your personal and professional growth, as we champion the principles of inclusivity and equity in all that we do.
Watch to learn more about Valera Health here!
About You:
As a Prior Authorization Specialist at Valera Health, you will play a vital role in ensuring the efficiency and accuracy of our billing processes. Your responsibilities include developing and streamlining pre-certification, authorization, and referral processes, ensuring compliance with insurance requirements.
In addition, you will coordinate with insurance entities, review organizations, and clinical contacts, as well as work with our Operations Intake team & Care Coordination team to coordinate authorization intake forms (to be developed) and ensure effective communication and benefit determination.
Finally, you will need to facilitate peer-to-peer reviews for escalated encounters and address inquiries from providers, staff, and patients as well as clinical staff at the payers.
You will have to define the tools needed to help monitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain/update the ordering detail, as information comes from all over the Valera system. In some cases, you have to be involved in educating the Care Coordinators & Health Connectors to document determinations made by the payer and ensure proper communications are delivered to the patient and providers.
Responsibilities:
75%
- Responsible for confirming and satisfying all authorization billing requirements for mental health / behavioral health / telehealth therapy services by obtaining appropriate precertification/authorization from all necessary payers to avoid delays in patient treatment and prevent claims denials for missing/invalid pre-certification/authorization.
- Must be capable of building database of Payor Prior Authorization requirements for each diagnosis identified by Prescribers and therapist
- Duties include monitoring assigned Authorization/Referral work queues. Understanding payor guidelines for authorization/referral policies, timely submission, tracking, and documentation of all precertification/authorizations required for upcoming services, based on therapy plan of care.
- Screens and analyzes patient medical records, in EMR, Care Manager, and Practice Manager as needed, for required provider documentation to ensure medical necessity requirements are met in accordance with payor guidelines and any other contractual authorization entity.
- Confer with clinical and supervisory staff to ensure that clinical information provided to payors is accurate and appropriate.
20%
- Responsible for the timely submission, tracking, and documentation of all precertification/authorizations required for upcoming services, based on outlined therapy plan of care. Will need to ensure the Prior Authorization number is loaded into the EMR for billing of services, as required by the payer.
- Monthly report out required for prior month activity.
- Maintain a current understanding of payor guidelines for authorization/referral policies.
- Authorization process for our mental health and behavioral telehealth therapy.
5%
- Maintains confidentiality when working with patient accounts, protected health information, and release of records. Complies with HIPPA guidelines to protect patient data privacy.
Qualifications / Background & Experience:
- 1-2 years of relevant experience in medical billing and/or Prior Authorization within a healthcare practice
- Experience with an Electronic Medical Record (EMR) and practice management system
- Knowledge of Medicare/Medicaid and major insurance carrier's guidelines
- Working knowledge of ICD-10 medical coding and billing and medical terminology
- Superior verbal and written skills are a must, as are sound judgment, maturity, and the ability to establish good rapport with employees, patients, physicians, and vendor
Compensation:
In compliance with all states and cities that require transparency of pay, the compensation for this position ranges from $60,000 - $65,000. Note wages may vary based on experience, location, and skills.
Physical Demands:
Occasional (0-40%) / Frequent (41-71%) / Constant (72-100%)
- Constant computer work which may require repetitive motion, prolonged periods of sitting, and sustained visual and mental applications and demands.
- Occasional lifting, bending, pulling, collating, and filing, some of which could be heavy (>10 lbs).
Benefits include but not limited to:
- Health Insurance
- Vision/Dental
- 401k
- Paid Time Off
- STD
- Life Insurance
- And many more
Be part of our mission!
We are very proud of the work that we do and it takes a great team to make it happen! If you are interested in one of our open positions, we'd love to start the conversation.
We hire people from all backgrounds because that's what it takes to build a team that can reach and support those in need of high-quality behavioral healthcare. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.
Check us out on Linkedin!
