Prior Authorizations & Verification of Benefits Specialist

COMPANY OVERVIEW:

At Holon Health, we are dedicated to revolutionizing the way healthcare services are delivered. With a strong focus on community health, we strive to provide support and solutions that address the whole health needs of people with Substance Use Disorder (SUD). We help these individuals navigate chronic medical conditions, SUD, and Behavioral Health needs with a focus on prevention, integrative treatment, and recovery.

Holon Health’s initiatives develop, support, and maintain relationships with provider partners and community-based organizations to promote programs advocating long-term health and wellness for this complicated population. By acting as the first point of contact for the justice systems and programs with whom we partner, Holon Health provides timely and efficient brief interventions to better prepare clients to receive community-based services and engage in proactive, prosocial behaviors.

WHO WE ARE:

The Holon Health team member is a dynamic individual who possesses meticulous attention to detail and excels as a team player. They possess effective communication skills, along with grit, tenacity, and resilience to navigate challenges. Demonstrating compassion and empathy, they approach interactions with sincerity and understanding. Additionally, their ability to inject a touch of playfulness adds a unique and positive element to the workplace. They exhibit relentless curiosity to understand the why, never relying on the shortcut of assumptions. Guided by a strong moral compass, they consistently strive to bring the wow factor to every aspect of their work.

POSITION SUMMARY:

The Prior Authorizations & Verification of Benefits Specialist plays a crucial role in ensuring seamless access to our CoCM services for clients. This position is responsible for obtaining necessary prior authorizations from insurance providers and verifying client insurance benefits to determine eligibility and coverage for health services, specifically within the CoCM framework. The ideal candidate is highly organized, detail-oriented, and possesses excellent communication skills. Experience with mental health billing and a deep understanding of insurance processes are essential.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Obtain prior authorizations from insurance companies for CoCM services, including initial assessments, ongoing treatment, and other related services.
• Verify client insurance benefits (eligibility, coverage, and co-pay/co-insurance information) for health services, specifically related to CoCM.
• Maintain accurate records of all prior authorizations and benefit verifications, ensuring data integrity and compliance.
• Communicate effectively with insurance providers, clinicians, and clients regarding authorization status, benefit information, and any potential issues.
• Proactively follow up on pending authorizations and appeals, escalating issues as needed.
• Stay up-to-date on insurance requirements, policies, and regulations related to CoCM.
• Collaborate with the RCM team to ensure accurate claim submissions and minimize claim denials.
• Identify and resolve any discrepancies or issues related to prior authorizations and benefit verifications.
• Contribute to the development and improvement of processes related to prior authorizations and benefit verifications.
• Maintain confidentiality of patient information in accordance with HIPAA regulations.
• Other duties as assigned.

QUALIFICATIONS:

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
• Minimum 3 years of experience in insurance verification.
• 1-3 years experience with prior authorizations submission and management.
• Medicaid and Medicare experience highly desired.
• Strong understanding of insurance processes, including prior authorization requirements, appeals processes, and claim submission procedures.
• Experience with CoCM billing and coding is a plus.
• Excellent communication (written and verbal) and interpersonal skills.
• Strong organizational skills and attention to detail.
• Ability to work independently and as part of a team.
• Proficiency in using electronic health records (EHR) and other relevant software systems.
• Knowledge of HIPAA regulations and patient privacy.
• Ability to work in a fast-paced, startup environment.

WHAT WE OFFER:

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Short- and Long-Term Disability
• Legal Assistance
• Telemedicine
• Accident
• Hospital Indemnity
• Critical Illness
• Legal Assistance
• 401k with company match and immediate vesting
• $150 remote work allowance
• Unlimited PTO
• Ample room for growth