Job Description

Authorization Specialist (Remote)

Kolmac Integrated Behavioral Health and Concerted Care Group (CCG) is a leading outpatient treatment provider in the Mid-Atlantic region. We are committed to treating individuals whose lives have been impacted by substance use and mental health disorders. We do this by providing compassionate and evidence-based treatment, aimed at improving the quality of life for those we serve.

We stand behind our commitment to diversity, equity and inclusion, which are the core of our company with our patients and employees. Our leadership team invests to enhance the programs we offer patients to expand access to care and offer flexibility. Patient care is at the heart of everything we do. We want your experience and expertise on our team! When you join our organization, you are connecting to a committed and caring group of colleagues.

We are currently in search of an experienced Authorization Specialist (Remote) for our Burtonsville, MD office. The Authorization Specialist's main function is to secure prior authorization for our patients from commercial and government payers. This position serves as the liaison between many other teams and provides excellent customer service to employees, patients, and outside vendors by using their knowledge of how insurance verifications, medical policies, and insurance requirements/guidelines operate.

Responsibilities

• Manages daily work queues to ensure prior authorizations are submitted within the company policy and timeline
• Identify and document each payer's policy and procedures regarding coverage and items that require prior approval
• Identify and document each payer's submission process
• Submit prior authorizations for approval
• Follow up with payers to check status of previously submitted prior authorizations
• Collaborate with care operations, clinical, and partnerships teams to resolve prior authorization denials
• Enter all documents, client data, new payer data, or responses regarding prior authorization into company systems
• Be highly responsive and communicate any changes in client's prior authorization status to care operations, clinical, and partnerships teams
• Experience in Behavioral Health (Preferred)
• Experience in Behavioral Health prior authorization processes (Preferred)
• Verifies insurance eligibility, benefits, pre-certifications, prior authorizations, and referrals requirements for scheduled outpatient services via telephone and/or insurance websites
• Documenting all details in the department's electronic medical record keeping systems accurately including linking all authorizations accurately
• Contact clinicians to obtain clinical documentation that is required by the insurance company
• Validate that the clinical documentation received is what is required by the plan
• Follow up on all pending PAs within 48 hours
• Utilizing the ability to multitask, prioritize and self-motivate to achieve set team and department goals
• Other duties as assigned

Qualifications

• High School Diploma/ Equivalent preferred
• 3+ years of experience in the insurance or health care field required
• Experience with Major Medical Insurance
• Knowledge of Pharmacy Benefit
• Knowledge of Revenue Codes
• Knowledge of HCPC Codes
• Knowledge of ICD-10 Codes (Diagnoses Codes)
• Familiar with the use of a personal computer and other essential office equipment including email software, printer, scanner, copier, fax machine and office telephone required
• Basic insurance and manage care structure knowledge required
• Familiar with hospital electronic medical records systems
• Effective verbal and written communication skills required
• The ability to multi-task, prioritize and self-motivate daily
• The ability to walk, sit, lift and stand for extended periods of time

We offer competitive compensation, full benefits, life insurance, 401K, tuition reimbursement, paid professional development time, student loan repayment program, paid vacation time, and more!

Kolmac Integrated Behavioral Health has been a leader in Outpatient Treatment since 1973. Patient care is at the heart of what we do. Kolmac Outpatient Recovery and Concerted Care Group (CCG) have merged to provide addiction treatment and behavioral health treatment services for individuals, families, couples, and groups. We serve communities across Maryland, DC, Virginia, Delaware, and Pennsylvania. We are still growing!

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