Long Term Care/Nursing Home Authorization Specialist
Job Description
Job DescriptionDescription:
Position Overview: Custodial Authorization Specialist
The Custodial Authorization Specialist oversees the long-term care residents’ authorizations on
behalf of clients. The Custodial Case Manager is responsible for obtaining authorizations and
maintaining authorization and insurance coverage throughout the patient's stay. The Custodial
Case Manager reports to the Supervisor of Custodial Case Management.
Key Results Area
• Puts forth best efforts to learn and understand full training provided upon onboarding.
• Maintains knowledge of Managed Medicaid rules for applicable states.
• Completes a minimum of 120 authorizations per month post 90 days of hire.
• Maintains an average of less than 30 pending authorizations at any given time.
• Ability to decipher medical records to determine medical necessity and insurance
submission requirements.
• Review the client's daily census for payer changes and request authorization
accordingly.
• Maintains an average of 30 days or less on turnaround time for authorization
determination.
• Ensures authorizations are up to date, requesting renewals as due.
• Responds to clients and outside billing companies regarding questions surrounding
custodial authorizations.
• Navigate multiple online portals when handling verifications, authorization submissions,
and status updates.
• Maintains time clock, requests, and takes PTO according to HR policies.
• Foster a collaborative work environment between the custodial team and the various
case management teams.
• Respond to client emails and requests by the end of business day.
• Manages workload and prioritizes daily tasks independently.
• Participate in monthly 1:1 meetings with the supervisor.
• Collaborates with colleagues, helping and handling additional cases during downtime or
a lull in individual caseload.
• Communicates respectfully with colleagues and leadership.
• Evaluate and assess personal performance on a routine basis.
• Agree to uphold and practice company principles (GUIDE) in all work-related
interactions.
Requirements:
• High School Diploma or GED.
• 1+ years of experience with medical terminology.
• Independent and self-motivated.
• Innovative and detail-oriented professional with strong research and organizational skills.
• Thrives in a fast-paced, high-pressure environment.
• Strong time management with a proven ability to meet deadlines.
• Solid collaborative skills with team and clients.
• Excellent proactive written and verbal communication supporting client satisfaction and retention.
• Ability to work remotely and autonomously.
• Ability to establish and maintain positive relationships.
• Ability to communicate and exchange information and ideas so others will understand.
• Demonstrate discretion, sensitivity, and ability to maintain confidentiality.
• Quality camera to be used when joining internal and client meetings scheduled via Zoom or Teams or other video meeting platforms. When participating, focus on the matter at hand. Refrains from actively performing other duties even if work-related.
• Joins scheduled client meetings timely, best practice 3 minutes prior to meeting time, to ensure the best self and company representation.
• Microsoft Office proficiency, with the aptitude to learn new programs.