The Stepping Stones Group is transforming the lives of children, families, and communities together through our exceptional therapeutic and behavioral health services. We believe our Core Values embody the culture of our organization: Trust, Integrity, Results, Quality, Community, and Inclusivity.
Job Title: Authorization & Eligibility Representative
Company: Community Autism Services - The Stepping Stones Group
Location: Remote but must reside in IL, MA or GA
Job Type: Full-time, Monday – Friday
Role and Responsibilities:
As an Authorization & Eligibility (A&E) Representative, you will play a crucial role in managing the authorization and eligibility process for clients seeking Behavioral Health Services, such as Applied Behavior Analysis (ABA) services, treatment for Autism Spectrum Disorder (ASD), Mental Health services, and Speech and Related Services. Your core responsibilities will include, but are not limited to:
- Funding Verification: Review insurance documents, referrals, ISA/IEPs and diagnosis reports to ensure client is eligible for services and/or provided sufficient information to run a benefit check.
- Client Profile Management: Update client profiles with necessary information including claim settings, labels, and funder details.
- Benefit Checks and Cost Projections: Conduct benefit checks and cost projections to confirm clients are in-network and services are covered. This includes verifying place of service coverage, prior authorization requirements, telehealth coverage, copayments, deductibles, out-of-pocket maximums, and coordination of benefits. Perform monthly benefit checks on all clients to ensure continuous coverage.
- Client Communication: Prepare and send cost projection forms and explanations of benefits to families, along with credit card consent forms.
- Authorization Requests: Complete and submit treatment request forms for evaluations, assessments, and on-going treatment and follow up with funders to confirm receipt. Follow up for status updates as needed.
- Report Review: Review clinical progress reports and treatment request forms (TRFs) before submission to funders.
- Submission Management: Submit progress reports and authorization requests via fax, email, or provider portals.
- Authorization Monitoring: Monitor fax, email, and provider portals for authorization approvals or denials, and ensure timely resubmission of expiring authorizations to keep them current.
- Data Entry: Accurately enter authorization details into Central Reach (CR), ensuring cross-referenced accuracy between authorization requests and approvals.
- Team Communication: Regularly update Clinical, Operational, and Intake Teams on the status, denial, or approval of authorization requests.
- Funder Relations: Maintain strong relationships with funder representatives to address feedback on authorization edits, etc.
- Billing Collaboration: Collaborate with the billing team to resolve unclear funding situations.
- Cross-Departmental Projects: Work closely with various departments on special projects as needed.
- KPI Reporting: Report on daily, weekly, and monthly submissions, kickbacks, temporary authorizations, etc.
Qualifications:
- Education: High school diploma or equivalent required; associate or bachelor’s degree in a related field preferred.
- Experience: Minimum of 1-2 years of experience in a healthcare or insurance-related role, preferably with a focus on authorizations, eligibility, and Behavioral Health Services.
- Skills:
- Strong understanding of health insurance processes and terminology.
- Proficiency in using electronic health records (EHR) systems, preferably Central Reach.
- Excellent organizational and time management skills.
- Strong attention to detail and accuracy.
- Effective communication skills, both verbal and written.
- Ability to work independently and as part of a team.
- Technical Proficiency: Comfortable using Microsoft Office Suite (Word, Excel, Outlook) and other office software.
- Interpersonal Skills: Ability to handle sensitive and confidential information with discretion.
- Problem-Solving: Strong analytical skills to review and interpret health plan criteria and client information.
- Customer Service: Commitment to providing exceptional support and service to clients and team members.
- Flexibility: Willingness to adapt to changing priorities and business needs.
- Responsive Communication: Answer phone calls, emails, and Teams chats within a 24 – 48-hour turnaround time.
- Team Support: Provide backup support for the Authorization & Eligibility team as needed.
Benefits:
- Health Insurance: Comprehensive medical, dental, and vision coverage.
- 401(k) Plan: Contributions to a retirement savings plan.
- Life Insurance: Basic life insurance coverage, with options to purchase additional coverage.
- Paid Vacation: Accrued vacation days based on length of service.
- Paid Sick Leave: Sick days for illness or medical appointments.
- Paid Holidays: Paid time off for company-recognized holidays.
The Stepping Stones Group is an Equal Opportunity Employer.
This job description aims to outline the primary duties and responsibilities for the role of an Authorization & Eligibility Representative. You will be expected to perform other duties as required to meet the organization's ongoing needs.
#INDH
Job Type: Full-time
Pay: $19.00 - $21.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Weekly day range:
Location:
Work Location: Remote