CommuniCare Health Services is currently recruiting for the key position of Part B Authorization Specialist supporting our Rehabilitation and Revenue Cycle Departments.
This is a remote position.

QUALIFICATIONS

• Must be able to work independently and prioritize high volume of daily requests.
• Must have general understanding of Healthcare Managed Care authorization process.
• LTC experience preferred

OPTIONAL AND BENEFICIAL EXPERIENCES

• Experience with health insurance
• Point Click Care experience
• Clinic Healthcare Experience
• Smartsheet
• Net Health

ABOUT US

A family-owned company, we have grown to become one of the nation’s largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, “to reach out with our hearts and touch the hearts of others.” Through this effort we create “Caring Communities” where staff, residents, clients, and family members care for and about one another.

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PURPOSE/BELIEF STATEMENT

Under the general supervision of the Corporate Director of Revenue Cycle, the Part B Prior Authorization Specialist will assist in the prior authorization process for all Part B Therapy services for all payors.

JOB DUTIES/RESPONSIBILITIES

• Processes requests for prior-authorization based on established therapy guidelines and contract criteria.
• Keeps abreast of industry trends and regulatory changes in the healthcare industry and incorporates knowledge in the performance of job duties.
• Identifies problems in process/procedures and makes recommendations for improvements.
• Maintains a balance of productivity, quality, and timeliness of job accountabilities
• Maintains and updates internal databases (Smartsheet, PCC, Net Health) as applicable
• Obtains prior authorizations per Rehabilitation Department’s request and maintains the database to communicate and track new and extended authorizations
• Ensures database information and appended files are current and accessible to staff
• Provides training and tools on the prior authorization process to new hires
• Generated reports on a monthly and as requested basis to the Rehabilitation and Revenue Cycle teams
• Creates and supports an environment which fosters teamwork, cooperation, respect, and diversity
• Establishes and maintains positive communication and professional demeanor with employees and payors at all times
• Performs other related duties as assigned
• Attends required training