Payer Authorization Coordinator

Position Summary

Reporting to the Manager, Background & Authorization, the Payer Authorization Coordinator will manage initial and reauthorizations for Medicaid and Non-Medicaid payers in all States for Careforth consumers. This individual will procure, track, and document electronic authorizations and manage oral and written communications related to authorization activity as appropriate. The Payer Authorization Coordinator will work with branch staff and medical billing staff to identify issues and will maintain the payer information in the system of record for consumers and temporary databases as needed. This position will work with external payer/partner organizations to correct and/or expedite authorizations for services with Careforth/Caregiver Homes. The Payer Authorization Coordinator will be familiar with state and payer regulations and the specific process requirements for all participating partners.

What You Will Do:

• Coordinate the required authorizations with payers for Careforth consumers and members as required by state regulations and Careforth policy
• Enter accurate information into the systems of record, as well as payer systems to ensure regulatory and compliance deadlines are met 
• Work collaboratively with branch staff, Careforth management, and payer representatives to reconcile disparities within data received and data entered (i.e. level of care) telephonically and via email 
• Work closely with internal stakeholders to assure continuity of care for existing consumers and prompt authorization approvals for new referrals
• Maintain payer information and consumer information as appropriate to maintain continuous authorization coverage through data entry (e.g. dates of service, renewal dates, etc.) 
• Ensure payer authorizations are compliant with all necessary state and federal regulations
• Create and maintain thorough and compliant documentation, including routine and adhoc updates 
• Develop tracking and outreach systems to assure continuation of coverage
• Provide routine updates to internal stakeholders on the status, content, and issues related to specific payers/state operations; Act as subject matter expert for rules and processes related to each payer 
• Perform other duties as assigned

What You Will Bring:

• Associate’s Degree preferred and/or equivalent experience 
• Minimum of 2 years’ experience in the health care field; experience with insurance and authorizations is highly preferred
• Understanding of Medicare, Medicaid and other third-party insurance billing practices and eligibility for services is required 
• Ability to multitask in a fast paced, ever evolving work environment
• Proficiency with Microsoft Office, excel proficiency required 
• Excellent oral and written communication skills
• Excellent customer service and organizational skills as well as attention to detail

You'll Benefit From:

At Careforth your well-being matters. With flexible schedules, a remote-first culture, and a nationally recognized wellness program, our benefits are designed to help you thrive, both professionally and personally. Discover how we invest in you: https://careforth.com/careers/#benefits

The pay range for this position is $18.45 - $24.87 hourly. The actual wage offered may be lower or higher depending on budget and candidate experience, knowledge, skills, qualifications, and geographic location.

#LI-Remote except for CA

Salary : $18 - $25