Crossroads Treatment Center
Hybrid Authorization Specialist - Greenville, SC
Crossroads Treatment Center, Greenville, South Carolina, us, 29610
Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Crossroads is a leading addiction treatment provider of outpatient medication-assisted treatment (MAT). We treat patients with opioid use disorder (OUD) using medications such as methadone and suboxone/ buprenorphine. We pride ourselves in supporting our patients' medical and personal recoveries from substance use disorder. Starting our fight against the opioid addiction crisis in 2005, Crossroads has remained physician led and patient focused as we've grown to 100+ clinics across nine states. As an equal opportunity employer, we celebrate diversity and are committed to an inclusive environment for all employees and patients.
Day in the Life of an Authorization SpecialistReview patient accounts flagged for prior authorization request needs. Will process authorizations by phone, fax, and portals for multiple payer types and various state Medicaid.Other duties will be obtaining retro authorizations, appeals, and reviewing medical charts for medical necessity.Research and processes eligibility requests according to business regulation, internal standards, and processing guidelines. Verifies the need for prior authorizations or the need for retro billing.Coordinates with internal departments to work changes in payor billing guidelines, updating the patient identification, other health insurance, provider identification and other files as necessary.Responsible for processing authorizations. Receiving approval for all services Crossroads provide. Research and appealing denied authorizations.Must possess a good working knowledge of payer eligibility guidelines, payer portals, and clearinghouses to ensure a complete verification of benefits.Responsible for tracking and organizing status of authorizations, inputting authorization numbers into the EMR, and scanning proof of authorization obtained into patients' charts.Responsible for all missing authorization related denials to identify trends to improve reimbursement rates.Responsible to work all authorization requests within a 24/48-hour turnaround time from receipt.Understands and adheres to state and federal regulations and system policies regarding compliance, integrity, and ethical billing practices.Must complete Relias training.Other duties as assigned.Education and Experience requirements
Must have had at least 4 years electronic insurance verification, real time eligibility, and/or billing experience in a hospital and/or physician office setting.General Knowledge of HCPCS, CPT-4 and ICD9-10 coding and/or medical terminology.Familiar with multiple payer requirements and regulations for utilizing benefits.Hours and Schedule
Position will be fully in office during training period which may vary depending on candidate's ability to meet competency requirements. Once requirements have been met, the employee may transition to working three days in office per week and two days remote.
Benefits Package
Medical, Dental, and Vision InsurancePTOVariety of 401K options including a match program with no vesture periodAnnual Continuing Education Allowance (in related field)Life InsuranceShort/Long Term DisabilityPaid maternity/paternity leaveMental Health DayCalm subscription for all employees
Crossroads is a leading addiction treatment provider of outpatient medication-assisted treatment (MAT). We treat patients with opioid use disorder (OUD) using medications such as methadone and suboxone/ buprenorphine. We pride ourselves in supporting our patients' medical and personal recoveries from substance use disorder. Starting our fight against the opioid addiction crisis in 2005, Crossroads has remained physician led and patient focused as we've grown to 100+ clinics across nine states. As an equal opportunity employer, we celebrate diversity and are committed to an inclusive environment for all employees and patients.
Day in the Life of an Authorization SpecialistReview patient accounts flagged for prior authorization request needs. Will process authorizations by phone, fax, and portals for multiple payer types and various state Medicaid.Other duties will be obtaining retro authorizations, appeals, and reviewing medical charts for medical necessity.Research and processes eligibility requests according to business regulation, internal standards, and processing guidelines. Verifies the need for prior authorizations or the need for retro billing.Coordinates with internal departments to work changes in payor billing guidelines, updating the patient identification, other health insurance, provider identification and other files as necessary.Responsible for processing authorizations. Receiving approval for all services Crossroads provide. Research and appealing denied authorizations.Must possess a good working knowledge of payer eligibility guidelines, payer portals, and clearinghouses to ensure a complete verification of benefits.Responsible for tracking and organizing status of authorizations, inputting authorization numbers into the EMR, and scanning proof of authorization obtained into patients' charts.Responsible for all missing authorization related denials to identify trends to improve reimbursement rates.Responsible to work all authorization requests within a 24/48-hour turnaround time from receipt.Understands and adheres to state and federal regulations and system policies regarding compliance, integrity, and ethical billing practices.Must complete Relias training.Other duties as assigned.Education and Experience requirements
Must have had at least 4 years electronic insurance verification, real time eligibility, and/or billing experience in a hospital and/or physician office setting.General Knowledge of HCPCS, CPT-4 and ICD9-10 coding and/or medical terminology.Familiar with multiple payer requirements and regulations for utilizing benefits.Hours and Schedule
Position will be fully in office during training period which may vary depending on candidate's ability to meet competency requirements. Once requirements have been met, the employee may transition to working three days in office per week and two days remote.
Benefits Package
Medical, Dental, and Vision InsurancePTOVariety of 401K options including a match program with no vesture periodAnnual Continuing Education Allowance (in related field)Life InsuranceShort/Long Term DisabilityPaid maternity/paternity leaveMental Health DayCalm subscription for all employees