Code: AUTH - 107
Revision Date: August 29, 2022
$15.30 - $21.42 Hourly
$1,224.00 - $1,713.60 Biweekly
$31,816.00 - $44,558.00 Annually
are an agency committed to innovative behavioral health services in
trauma-informed care that promote healing and recovery to instill a sense of
empowerment and foster a lifelong sense of resilience.
purpose of this job is to verify benefits and eligibility of clients'
inquiries, preparing authorization folders, indicating co-pays/deductibles in
client's record, providing ongoing patient benefit information, secures
authorizations for all paying sources.
class works under close to general supervision according to set procedures but
determines how or when to complete tasks.
functions listed below are those that represent the majority of the time spent
working in this position. Management may assign additional functions related to
the type of work of the position as necessary.
- Provides training material to
EHN staff in order to ensure authorization requirements are met.
- Contacts representatives at
insurance companies and organizes educational training.
- Verifies eligibility and
benefits for all clients.
- Communicates benefit
information and co-payments to front office coordinators and reimbursement
specialists must be made when needed.
- Ensures all pre-authorization
calls and paperwork are addressed and completed in an accurate and timely
- Contacts the appropriate
payors to obtain treatment authorization numbers, reimbursement
structure, and client eligibility. Upon receipt of scheduled appointment,
verification of eligibility and benefits for all clients must occur.
- Maintain ticker filing system
for authorizations and benefit expiration.
- Completes the telephone
profile of insurance benefits in a timely fashion.
- Assures concurrent reviews
Outpatient Treatment Requests (OTR) forms are completed accurately and
appropriate signatures are obtained.
- Assigns the correct financial
class and adjust financial class as required.
- Notifies the appropriate
departmental director of any potential problems related to an
- Completes a demographic
pre-certification if required.
- Completes the authorization
folder within one working day of obtaining authorization, and schedule
all critical dates for appropriate follow up:
- Ensures written confirmation
of benefits and eligibility is sent to the primary and secondary
insurance carrier and scheduled for follow up.
- Documents all activity
occurring during the authorization process as it pertains to eligibility,
benefits, reimbursement and required signatures.
- Coordinates with other
departments within EHN to assure appropriate usage of client benefits
for treatment extensions when appropriate, as well as coordinating
coverage limits and other length of stay issues for clients.
- Collaborates and assist
Reimbursement Specialist with denials related to authorization and
- Ensures denials are below 3%
due to authorized services.
- Collaborates and assist
Reimbursement Specialist with the Fiscal Balance Aging Report follow up as
it pertains to their assigned payor.
- Adheres to EHN, department,
personnel and standard policies and procedures.
- Adheres to EHN standards
concerning conduct, dress, attendance and punctuality.
- Supports facility-wide
quality/performance improvement goals and objectives.
- Maintains confidentiality of
EHN employees and patient information.
- Performs other duties as
Education and Experience Requirements
an Associate's Degree and one (1) year of experience in a medical/behavioral
health setting verifying eligibility; or equivalent combination of education,
training, and experience which provides the required knowledge, skills, and
with trauma-informed services; cognitive behavioral therapies, including DBT;
and motivational therapies including the use of incentives, preferred.
Knowledge and Abilities
of trauma-informed theories, principals, and practices (includes multi-faceted
understanding of concepts such as community trauma, intergenerational and historical
trauma, parallel processes, and universal precautions), preferred.
sedentary work that involves walking or standing some of the time and involves
exerting up to 10 pounds of force on a regular and recurring basis or sustained
Hazards (Work Environment)
- Involves routine and frequent
light; Dusts and pollen.
extreme hazards not listed above.
Certifications and Licenses
- Must possess and maintain a valid
state Driver's License with an acceptable driving record.
- Must be able to pass a TB,
criminal background and drug screen.
with Disabilities Act Compliance (ADA)
Health Network is an Equal Opportunity Employer. ADA requires Emergence
Health Network to provide reasonable accommodations to qualified persons with
disabilities. Prospective and current employees are encouraged to discuss ADA
accommodations with management.
- Staffing requirements,
including criteria that staff have diverse disciplinary backgrounds, have
necessary State required license and accreditation, and are culturally and
linguistically trained to serve the needs of the clinic's patient
- Credentialed, certified, and
licensed professionals with adequate training in person-centered, family
centered, trauma informed, culturally-competent and recovery-oriented
Note: This Class Description does not constitute an employment
agreement between the Emergence Health Network and an employee and is subject
to change by the Emergence Health Network as its needs change.