Authorization Specialist Details

Authorization Specialist

MGA Homecare - Dallas, TX

Employment Type : Full-Time

Company Description

MGA Homecare specializes in providing private duty nursing, personal care services, and therapy to the medically complex population. Compassion and integrity are at the heart of everything we do! We deliver high-quality care in the home and community-based setting; the setting which is the lowest cost to the payers. We aim to be the employer of choice and the partner of choice to referral sources, state government agencies, and health plans. We currently provide care in Arizona, Colorado, Texas, and North Carolina with a plan to grow into new states and markets.

We are growing and have an immediate opening for an Authorization Specialist to join our dynamic Dallas Team.

If you are seeking a rewarding career opportunity with a growing healthcare company that values its employees and patients, then apply now to join the MGA family!

Job Summary

Reports directly to the Administrator and ensures maximum third party reimbursement through monitoring insurance verification and authorization process. This position also communicates with provider/clinical staff/caregivers as necessary to obtain pertinent information and acts as the point of contact, aiding providers and organization.

Duties and Responsibilities

• Performs communication to obtain authorization of home health services.
• Interfaces with providers/office staff/clinical staff/caregivers for the purpose of attaining additional information required for authorization approval.
• Provides direct support regarding utilization, authorization, and referral activities.
• Updates patient demographics and insurance as needed.
• Assists in gathering information needed for coordinators, case managers, and clinical staff to determine continued authorization.
• Tracks frequency of visits on all visits for PDN and/or therapy patients.
• Contacts providers and families with authorization, denial, and appeals process information.
• Verifies eligibility of members and members benefit coverage.
• Assists with the identification and reporting of quality management and non-coverage issues.
• Responsible that all discrepancies are reported to the Director of Clinical Services, Director of Therapy, and Account Manager
• Cross Trained with Intake Specialist.
• Insurance knowledge experience AHCCCS(Arizona Medicaid), Aetna, BCBS, Cigna/CareCentrix, TriCare, United Health Care, etc.
• Performs all other duties assigned by Director of Clinical Services, Director of Therapy, and Account Manager.
• Supports and executes the mission, ethics, and goals of the company effectively.

Requirements / Preferences

• High School Education - *Associates Degree preferred
• Exceptional Customer Service
• Must be detailed oriented
• Familiarity with ICD-10 coding
• Able to work independently
• Ability to perform basic to intermediate applications with Excel
• Strong verbal and written communication skills (Additional languages preferred)
• 1+ year experience in a clinical environment preferred
• Requires in depth knowledge of benefits and authorizations
• Proficient use of standard computer programs for data entry and data organization

This is a full-time position that offers a starting hourly pay rate of $17-$23 per hour.

• Competitive wages
• Weekly pay
• Medical, Dental & Vision Coverage – Available 1st of the month following 30 days of employment
• Health Savings Accounts (HSA)
• Flexible Spending Accounts (FSA)
• Voluntary Short Term & Long Term Disability
• Employee Assistance Program (EAP)
• 401(k) retirement plan
• Paid Time Off (PTO)
• 7 Company Paid Holidays
• 100% Company Paid Life Insurance
• Voluntary Life Insurance
• Accident, Hospital, and Critical Illness Insurance
• Identity Theft Protection Plan
• Discounted Legal Care Plan

All your information will be kept confidential according to EEO guidelines.