Authorization Specialist

Company Description

Lingraphica is a mission-driven organization who provides speech-generating devices to help improve communication, speech, and quality of life for people with communication impairments. We look for candidates who enjoy working in a fast-paced, goal-oriented environment, and who share our commitment to helping individuals on their communccation journey.

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, Medicare, 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

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. 

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). 

Additional Information

Travel Requirements:

Occasional travel required to national conventions, conferences, annual company meeting and team off-sites, within the continental United States, approximately 2 – 4x / year.

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. 

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!

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.