Workers Compensation Authorization & Verification Specialist

The Workers Compensation (WC) Authorization and Verification Specialist will report to the WC Authorization and Verification Team Lead and will work in combination with front office teammates and any external authorization and verification vendors to ensure Ivy Health’s authorization and verification processes and workflows are executed successfully, set goals and best practices are achieved, and the risk of lost revenue is minimized. In this role, you will be driving both internal and external customer satisfaction through a focus on faster and more efficient reimbursement. The ideal candidate will not only ensure a positive experience for patients, providers, and fellow teammates but will also be a key contributor in optimizing and standardizing authorization and verification workflows within Ivy Health.  

Your responsibilities will include: 

• Submit authorization requests timely within EMR, following payer and state specific guidelines 

• Specialize in Workers Compensation Financial Class and fluidity within different state and payer specifics

• Partner with Front Desk teammates and/or Workers Compensation Centralized Scheduling (WCCS) teammates within clinics to ensure appropriate and accurate documentation for authorization submission is completed and uploaded for submission

• Provide regular feedback to front desk and/or WCCS regarding areas of opportunity in authorization or verification timeline or process

• Address and respond to authorization or verification related queries from Ivy teammates and WC Payers

• Ensure all authorization and verification related denials are addressed timely and accurately, providing denial prevention feedback to WC Team Lead

• Accurately complete verifications for same day or walk-in patients by contacting the provided insurance via phone, fax, or online portal to obtain outpatient therapy benefits, eligibility, and authorization information

• Request, follow-up, and secure authorizations prior to and during treatment episode for Workers Compensation patients 

• Assist with training and education for new A&V teammates as well as ongoing training and education for established team members 

• Maintain a professional and collaborative relationship with all teammates and vendors to resolve issues, increase knowledge of insurance requirements, and create standardized workflows 

• Run EMR or BI reports as needed to monitor maximum benefits, missing authorization, or other areas of focus as determined by the A&V Team Lead

• Attend and participate in Department and Organizational meetings to discuss departmental goals and progress

• Perform other duties as assigned by leadership staff

To excel in this role, you should possess:

• Experience with Workers Compensation insurance in the therapy arena preferred

• Demonstrates flexibility in responding to priorities and organizational change.

• Demonstrates ability to work under pressure and follow through on assignments 

• 2-3 years previous experience in pre-auth verification; experience with obtaining authorizations, referral coordination and patient services preferred

• Ability to multi-task, prioritize needs to meet required timelines.

• Customer service experience 

• Effective written and verbal communication skills.

• Solution oriented mindset and ability to use critical thinking and analytical skills 

• Ability to use standard office equipment to include copiers, fax machines, and other methods of electronic communications.

• Open availability Monday through Friday from 8am-5pm EST

• Ability to self-motivate and focus in a remote position

• Proficient in Microsoft applications

Why choose Ivy Health?  

• Exceeding Expectations:Deliver best-in-class care and witness exceptional patient outcomes.  

• Empowering Values: Live by values that prioritize teamwork, growth, and serving others.

Compensation Range: $20.00 - $23.00 per hour.

• This position is also eligible for a bonus.

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