Authorization & Referral Specialist

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    "description": "<p><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#003660\"><strong>Who is Comprehensive Healthcare?</strong></span><br />\n<span style=\"color:#000000\">Comprehensive Healthcare provides innovative behavioral health and integrated healthcare services to clients of all ages. We take pride in our creative and collaborative work environment and in delivering clinically excellent, trauma-informed, recovery-oriented services.</span><br />\n<br />\n<span style=\"color:#003660\"><strong>What are we looking for in an Authorization &amp; Referral Specialist?</strong></span></span><br />\n<span style=\"color:#000000; font-family:Arial,Helvetica,sans-serif\">This role supports authorization processes across multiple programs and service lines within the organization. The Authorization Specialist is responsible for coordinating and managing prior authorizations and referrals across the organization, including interpretation of payer requirements, verification of coverage, and ensuring compliance with authorization guidelines prior to service delivery.</span><br />\n<br />\n<span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\"><strong>Authorization Specialist&nbsp;duties may include:</strong></span></span></span></p>\n\n<ul>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Coordinates and manages prior authorizations across multiple programs within the organization. &nbsp;</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Participates in process improvement efforts related to authorization workflows and payer compliance.</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Reviews and interprets payer requirements to determine authorization necessity and coverage limitations prior to service delivery.</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Submits authorization requests with appropriate clinical documentation and ensures compliance with payer guidelines.</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Understands funding source requirements (i.e., Medicare, Medicaid, and private insurance).</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Performs detailed verification of insurance benefits and eligibility to support accurate authorization submission.</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Identifies and resolves discrepancies related to payer requirements, coverage, and authorization status.</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Monitors authorization timelines and proactively follows up to prevent delays or denials.</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Communicates payer requirements, authorization status, and coverage limitations to internal teams.</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Collaborates with clinical and administrative staff to ensure appropriate documentation supports medical necessity.</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Maintains current knowledge of Medicare, Medicaid, and commercial payer policies.</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Identifies potential financial liability scenarios and escalates as appropriate.</span></span></li>\n</ul>\n\n<p><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\"><strong>Qualifications:</strong></span></span></span></p>\n\n<ul>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">High school diploma or equivalent is required.&nbsp;</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Minimum one (1) year of experience in a healthcare setting required</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Minimum one (1) year of experience in insurance verification, prior authorizations, or healthcare revenue cycle functions required.&nbsp;</span></span></span></li>\n</ul>\n\n<p style=\"color:#000000; font-family:Arial,Helvetica,sans-serif\"><br />\n<span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><strong>Preferred qualifications:</strong></span></span></p>\n\n<ul>\n\t<li style=\"color: rgb(0, 0, 0); font-family: Arial, Helvetica, sans-serif;\"><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Two (2) to three (3) years of experience in healthcare, authorizations, or utilization management strongly preferred. Knowledge of Medicare, Medicaid, and commercial insurance payer requirements.</span></span></li>\n\t<li style=\"color: rgb(0, 0, 0); font-family: Arial, Helvetica, sans-serif;\"><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Experience working with prior authorizations across multiple service lines or programs.</span></span></li>\n\t<li style=\"color: rgb(0, 0, 0); font-family: Arial, Helvetica, sans-serif;\"><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Ability to interpret insurance benefits, coverage limitations, and authorization requirements.</span></span></li>\n\t<li style=\"color: rgb(0, 0, 0); font-family: Arial, Helvetica, sans-serif;\"><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Experience with electronic health records (EHR) and payer portals.</span></span></li>\n\t<li style=\"color: rgb(0, 0, 0); font-family: Arial, Helvetica, sans-serif;\"><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Understanding of coordination of benefits and payer hierarchy</span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"color:#000000; font-family:Arial,Helvetica,sans-serif\">Strong attention to detail and ability to analyze and resolve payer-related issues.&nbsp;</span></span></li>\n</ul>\n\n<p><br />\n<br />\n</p>\n\n<p>&nbsp;</p>\n\n<p><br />\n<span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#003660\"><strong>What Comprehensive Healthcare Can Offer You&nbsp;</strong></span></span><br />\n<span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\"><strong>Training and Development</strong></span></span></span></p>\n\n<p><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\"><strong>Innovative Program &amp; Services</strong></span></span></span></p>\n\n<p><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\"><strong>Excellent Benefits</strong></span></span></span></p>\n\n<ul>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">A variety of career opportunities in a wide range of settings with room for mobility and promotion</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Regular training opportunities including support, supervision, and consultation in implementing evidence-based services and programs</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">A strong reputation for providing quality, evidence-based services within a collaborative multi-disciplinary team environment&nbsp;</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Innovative, forward-looking leadership that seeks to thrive in an ever-changing healthcare environment</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Joint Commission-accredited organization committed to continuous quality improvement</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Established partnerships with major research universities and other community and healthcare providers to implement cutting-edge treatment programs and services</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Competitive salaries within our communities and industry</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Healthcare coverage for employee and qualified family members</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Generous vacation, paid holiday and sick leave policies</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Access to Employee Assistance Program services</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Agency-funded retirement plan with contributions equal to 5% of compensation</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Additional retirement investment opportunities with a 50% investment match of up to 4% of compensation</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Agency-funded life and disability insurance program&nbsp;</span></span></span></li>\n\t<li><span style=\"display:block; font-size:14px\"><span style=\"font-family:Arial,Helvetica,sans-serif\"><span style=\"color:#000000\">Financial incentives to further employee education</span></span></span></li>\n</ul>\n\n<p>&nbsp;\n<p>&nbsp;</p>\n</p>\n",
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