Authorization Specialist

  • Colorado Springs, CO, USA
  • Full-time

Company Description

About Us

MGA Homecare specializes in providing professional home healthcare services with a personalized touch. We focus on helping patients and their families by delivering high-quality clinical care with individualized attention and support. Our headquarters are in Scottsdale, Arizona with other offices containing clinical and administrative support teams in Texas and Colorado. Our goal is to make the lives of our families easier by demonstrating compassion and integrity in everything we do.

 

Job Summary

Reports directly to the Director of Clinical Services in conjunction with the Director of Therapy, and Account Manager and ensures maximum third party reimbursement through monitoring insurance verification and authorization process. This position also communicates with provider/clinical staff/caregivers as necessary to obtain pertinent information and acts as the point of contact, aiding providers and organization.

Job Description

Duties and Responsibilities

  • Organization Communication
    • Performs communication to obtain authorization of home health services.
    • Interfaces with providers/office staff/clinical staff/caregivers for the purpose of attaining additional information required for authorization approval.
    • Provides direct support regarding utilization, authorization, and referral activities.
    • Updates patient demographics and insurance as needed.
    • Assists in gathering information needed for coordinators, case managers, and clinical staff to determine continued authorization.
    • Tracks frequency of visits on all visits for PDN and/or therapy patients.
    • Contacts providers and families with authorization, denial, and appeals process information.
  • Verification
    • Verifies eligibility of members and members benefit coverage.
    • Assists with the identification and reporting of quality management and non-coverage issues.
    • Responsible that all discrepancies are reported to the Director of Clinical Services, Director of Therapy, and Account Manager
  • Cross Trained with Intake Specialist.

· Insurance knowledge experience

    • AHCCCS(Arizona Medicaid), Aetna, BCBS, Cigna/CareCentrix, TriCare, United Health Care, etc.
  • Performs all other duties assigned by Director of Clinical Services, Director of Therapy, and Account Manager
  • Supports and executes the mission, ethics, and goals of the company effectively.

o Represents themselves in a positive and professional manner in the company and community.

    • Adheres to dress code with a clean and neat professional appearance.
    • Reports on time and as scheduled to complete work within designated time.
    • Adhere to all company policies and procedures outlined in Employee Handbook, Employee Agreement, or communicated from executive team.

Qualifications

Requirements / Preferences

  • High School Education - *Associates Degree preferred
  • Exceptional Customer Service
  • Must be detailed oriented
  • Familiarity with ICD-10 coding
  • Able to work independently
  • Ability to perform basic to intermediate applications with Excel
  • Strong verbal and written communication skills (Additional languages preferred)
  • 1+ year experience in a clinical environment preferred
  • Requires in depth knowledge of benefits and authorizations
  • Proficient use of standard computer programs for data entry and data organization

Additional Information

  • Weekly pay at $16-$18/hr
  • In-office position

All your information will be kept confidential according to EEO guidelines.

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