Remote Insurance Authorization Jobs in Raleigh, NC

Enrollment and Authorization Specialist - Full Time

Join a supportive team who values Compassion, Excellence, Collaboration, Inclusion, Hope amp; Authenticity!

As our Enrollment and Authorization Specialist, you will be responsible for processing IPRS enrollments and Target Population enrollments, along with coordinating prior authorizations in a timely manner per the expectations of the agency, MCO, and state service definitions.

This role ensures accurate data entry, timely review of requests, and compliance with organizational, state, and federal guidelines. Additionally, the Enrollment and Authorization Specialist will support utilization management and quality assurance initiatives for assigned programs.

Schedule

FT, Monday - Friday.

Pay

$20.00 per hour.

Benefits

Being a part of a non-profit behavioral health organization has some unique benefits, along with our incredible health insurance options. Working here at SouthLight, you will be able to make a difference in people's lives every day, and know that you are a part of inspiring positive change in your community.

Full-time employees are eligible for medical benefits the first of the month 30 days after hire date. Options for a standard plan and an HSA plan with a $300 initial contribution and up to a $25 per paycheck match. 10 paid holidays and PTO hours which accrue at a rate of 10 hours per month. After 6 months employees are eligible to enroll in our 401(k) plan which has a 4% match. Company paid life insurance, short and long term disability, in house and paid training opportunities, and additional pay for working holidays.

Job Responsibilities of an Enrollment and Authorization Specialist

• Function as the office based/remote specialist as necessary according to service definition requirements
• Demonstrate understanding of eligibility criteria, service requirements, documentation standards, and intended population for the following behavioral health services; Medication Assisted Treatment (MAT)/Opioid Treatment Program (OTP), Community Support Team (CST), Peer Support Services (PSS), Substance Abuse Intensive Outpatient Program (SAIOP), Substance Abuse Comprehensive Outpatient Treatment (SACOT)
• Ensure time-sensitive enrollments are completed within regulatory deadlines
• Coordinate with staff members all relevant/required documentation needed to compose Service Authorization Request (SAR)
• Coordinate with staff members all relevant/required documentation and information needed to submit IPRS enrollments and updates, including proof of insurance termination, financial attestation forms, residency attestation forms, client contact information documentation, client diagnostic information, client IDs and any other needed documents required by Alliance
• Track pending authorizations and follow up on missing information
• Audit authorization documents for accuracy, ensuring criteria for service being requested have been met (ASAM, LOCUS, signatures etc.)
• Follow-up with program leads on any additional information requested by the payer source and address unable to process and denied authorizations in a timely manner
• Assist Leads/Managers in obtaining and disseminating reports related to billing, and authorization related information.
• Coordinate with staff members when Funding Source requires additional information for Authorization approvals

Qualifications of an Enrollment and Authorization Specialist

Education and Experience

• Bachelor’s degree in human services field or AA or HS with additional experience
• Two years’ experience working with the MH/SU population (directly or indirectly)
• Two years’ experience working in community mental health setting preferred
• Experience in insurance verification/MCO and commercial insurance portals a plus

Knowledge, Skills and Abilities

• Microsoft Office Suite experience required
• Experience with software applications (EHRs, Alpha MCS, etc.)
• Experience with insurance payers (MCOs, Commercial Plans, Medicare) preferred
• Excellent organizational skills and attention to detail
• Ability to multi-task, prioritize and meet deadlines
• Ability to communicate effectively with a wide variety of people
• Maintain flexible and coachable demeanor
• Ability to work within a team
• Comfortable working independently from remote location and/or office based
• Excellent written/ documentation skills.

About SouthLight Healthcare

Tap into your passion at SouthLight Healthcare. Build your career in an environment where your voice, passion and work matters every day. At the core of SouthLight is a commitment to our values, our employees and clients. We strive to be an organization where every colleague can contribute and excel. We are an equal opportunity employer and committed to building a culture that values diversity and inclusion. SouthLight offers competitive opportunities and a robust benefits package.

Founded in 1970, SouthLight Healthcare is one of the area's largest and long-established nonprofit providers of substance use treatment and mental health services. With outpatient and community-based programs, SouthLight provides prevention, education and treatment services in the Triangle and beyond. SouthLight has multiple office locations throughout the Triangle area, serving more than 9,000 clients each year. Services include adult outpatient counseling, Intensive Outpatient Program, Psychiatric Services and Medication Management, Opioid Treatment Program, Court Deferral Program, Peer Support Services, Family Centered Treatment, Community Support Team and a residential treatment program for women and children and more.