Authorization Specialist, Accounting - Charlottesville

General Statement Of Responsibilities

This is a FLSA non‑exempt position. The incumbent serves as administrative staff with specialized responsibilities for the Financial Access Department of the Administrative Division. In this capacity, he/she has primary responsibilities for requesting service authorizations to various insurance companies in a timely manner to obtain approval for the agency to provide service to clients.

The incumbent is under the direct supervision of the Fiscal Access Program Manager. He/she performs duties by proceeding alone under standard practices and referring questionable situations to the supervisor. Standard practices allow for the independent accomplishment of recurring tasks and use of own initiative for prioritizing the work schedule. Work includes ad hoc problem solving around assigned tasks. In carrying out position duties, he/she performs in accordance with applicable professional ethics and established Region Ten policies.

Position performance requires analysis of facts and determining action using a wide range of procedures but within the limits of standard practice. Duties require planning own work after definite objectives set by the supervisor with unusual situations referred to the supervisor.

• Request and obtain service authorizations from various insurance companies, using fax, internet, and/or phone to submit requisite clinical information to payers for review.
• Effectively respond to insurance companies’ time‑sensitive requests for additional information to maximize agency’s service approvals.
• Accurate and timely data entry of authorization approval into Credible once obtained from insurance companies.
• Assist clinicians in tracking and/or updating external authorizations by providing information to clinicians in a timely manner.
• Issue service limit and/or date expiration warnings to staff and management notifying them of over and/or under utilization.
• Manage clinicians’ internal requests for submitting authorizations.
• Notify supervisor of issues related to clinicians’ requests and/or insurance companies.
• Notify supervisor of any changes to payer rules and/or procedures noticed while submitting requests.
• Collaborate with other agency staff and functions in assuring accurate reimbursement related data entry.
• General secretarial duties as they relate to the authorization request process (i.e., copying, typing, faxing, and filing).
• Read all agency communication.
• Other duties and special projects as assigned by the supervisor.

EDUCATION:

High School Diploma Required.

KSAS Knowledge of third‑party billing, the service authorization process, DMAS/Medicaid eligibility criteria, working knowledge of mental illness, substance abuse, intellectual disability.

Skills in verbal and written communication; online authorization submission, proficiency with relevant screens of Credible; problem solving; computer and data management; basic record‑keeping; math; use of office equipment; data entry; customer service; interpersonal relations.

Abilities to collect information on third‑party payer(s) and others regarding benefits, reimbursement requirements, and authorization procedure; comprehend and maintain knowledge of principles, practices and methods of treatment modalities, analyzing data for patterns and trends; medical necessity, levels of care; be organized, efficient and accurate; communicate effectively with a wide variety of individuals; be decisive and think quickly; work well under pressure;

prioritize work and provide coverage in each of the functional areas; be client‑centered/customer oriented; work with both external and internal customers.

Grade:
8. Hourly Pay Range $19.11 - $28.66.

Schedule:

Full Time.

Location:

110 Avon Street, Charlottesville, VA 22902.