Authorization Specialist

Company Description

At Lingraphica we are dedicated to improving lives by helping individuals with speech and language challenges communicate more effectively regain independence and enhance their quality of life. Since our start more than 35 years ago we’ve combined compassionate support with advanced augmentative and alternative communication (AAC) devices software and community-based services to serve people with aphasia brain injury autism and other communication needs as well as their families care partners and clinicians. Grounded in our core values of Action Empowerment Improvement and Integrity we strive to create an inclusive supportive workplace where innovation meets genuine empathy and every team member has the opportunity to make a meaningful impact.

Job Description

Purpose: The Authorization Specialist’s main function is to secure funding approvals for our customers whether it be from private insurances State funding or any other type of funding source. This position serves as the liaison between many other teams and provides excellent customer service to employees as well as customers using their knowledge of how insurance verifications medical policies and insurance requirements/guidelines work. The Authorization Specialist is also responsible for maintaining accurate records of policies and insurances for employees to view and reference as needed.

Essential Duties & Responsibilities:

• Initiates prior authorizations pre-determinations and out-of-network gap exceptions.

• Initiates and follows through with authorization appeals.

• Follows up on all authorization requests in a timely manner and reports on progress to internal teams.

• Applies to and follows up on applications for funding through Government programs.

• Negotiates and obtains agreements with insurance companies for individual cases when necessary.

• Communicates internally and externally regarding authorizations appeals and exceptions.

• Assists in eligibility and benefits inquiries when necessary.

• Determines the authorization requirements of each health plan and keeps detailed records of the medical policies and requirements.

• Maintains accurate and complete documentation of all inquiries.

• Proactively communicates with team members regarding identified potential issues and concerns.

• Tracks patterns and trends of authorization issues from payers to eliminate future delays in authorization processing.

• Exhibits strong problem-solving skills through both verbal and written communications.

• Assists reimbursement team in authorization related corrections on rejected or denied claims.

• Answers in-bound calls and assists customers.

• Exercises the above with discretion and independent judgement.

• Performs other duties and works on special projects related to authorization.

Qualifications

Education & Experience:

• Bachelor’s Degree or equivalent combination of education and experience

• Familiarity with entire revenue cycle and terminology.

• Experience with insurance portals such as NaviNet and Availity.

• Experience with DME/Home Medical Equipment.

• Experience with healthcare claims (e.g. authorization billing collections).

Knowledge Skills & Abilities:

• Experience with prior authorizations pre-determinations and out-of-network gap exceptions.

• Proficient understanding of healthcare provider environment.

• Excellent problem-solving skills and attention to detail.

• Excellent customer service skills and professionalism.

• Ability to comfortably interface with various users across the organization.

• Proficiency with MS Outlook Word Excel Adobe.

• Knowledge of insurance requirements regarding face-to-face documentation.

Additional Information

Work Environment & Physical Demands: Incumbent works from home and is expected to maintain a safe productive work environment with secure internet access.  Must be able to operate a computer with or without a reasonable accommodation.

Travel: Travel may be required on occasion up to 2 – 4x / year

Accommodations: To perform this job successfully an individual must be able to perform each essential duty and physical demand satisfactorily. The requirements listed above are representative of the knowledge skills and/ or ability abilities and physical demands required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. To learn more about Lingraphica visit: www.lingraphica.com! Lingraphica and Pay Transparency

At Lingraphica we are committed to fair and equitable compensation practices. The starting salary range for this position is $50000 and $55000 per year. Placement in the starting pay is based on factors such as experience skills education and internal equity. We regularly review our compensation structures to ensure they align with industry standards promote fairness and support career growth. In addition to competitive base pay we offer a comprehensive benefits package and a commitment to fostering an inclusive and supportive workplace. We encourage open conversations about compensation and are dedicated to maintaining transparency throughout the hiring process.

• Paid Time Off (sick personal and vacation)

• Paid Company Holidays

• 401(k) Retirement Plan and Contribution

• Medical/Dental/Vision benefits with FSA HSA & Dependent care options

• Employer Paid Life Insurance

• Voluntary benefits such as Short- and Long-Term Disability Critical Illness Hospital Indemnity and AD & D insurance

• Stipends for health and wellness home office setup and professional development

• Paid Family Leave

• Annual bonus program

• Annual merit increases

• Year-Round Flex Friday’s

• Discounts on travel entertainment home/pet/car insurance

To learn more about Lingraphica visit: www.lingraphica.com! To learn more about our benefits offerings click here!

This Organization Participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

Este empleador participa en E-Verify y proporcionará al gobierno federal la información de su Formulario I-9 para confirmar que usted está autorizado para trabajar en los EE. UU.