Commercial Insurance Specialist
Description


The Commercial Insurance Specialist at Circle of Care is a key member of the authorization team. This individual is responsible for insurance requests and authorizations for any child covered by a commercial insurance policy who needs our care. Working in a fast-paced, growing organization, this position is focused on the ever-growing needs of the team in line with the CofC standard of patient care. This position will rely heavily on communication and multi-tasking abilities.


Circle of Care and Empower Behavioral Health are working together to provide quality care across a range of services. CofC provides in-home pediatric occupational, physical, and speech therapy services in Texas. EBH was created with the mission of empowering families by providing the most effective Applied Behavior Analysis (ABA) services, to ensure that learners with autism and other developmental disabilities reach their maximum potential. Together, these organizations have set out to provide the best care across pediatric occupational, physical, speech therapy, and ABA services. 


Join our compassionate and knowledgeable team of professionals as a Commercial Insurance Specialist and help us grow! 


Duties and Responsibilities:
 

  • Help assess/qualify referrals and obtain any necessary authorizations from commercial insurance companies.
  • Assist with identifying performance improvement processes for efficiency – the need is great out there!  Help us help children get the services they need.
  • Interact with points of contact throughout the commercial insurance companies we have contracts with to facilitate the authorization process in a timely fashion.
  • Work closely with physicians and other providers to gather necessary information for the patient to obtain proper services
  • Review concurrent forms and check that all supporting documents are complete and submitted.
  • Participate in daily team huddles to ensure communication is optimal.
  • Regularly follow up on authorization requests to keep the process moving
  • Track all authorizations and monitor timelines to escalate cases as needed
  • Promote the mission, vision, and values of Circle of Care
Requirements

Competencies:


Attention to detail

Excellent oral and written communication

Results Oriented

Customer Focus

Problem -Solving
Organizational Skills
 

Education and Experience:


Required

  • Associate degree or equivalent; or a minimum of 4 years of insurance or authorization-related experience 
  • Knowledge of Microsoft Outlook, Office, Word, and Excel
  • Experience with commercial insurance payors, authorizations, and credentialling
  • Experience with communicating with insurance companies
  • Previous knowledge/work in a medical office

Preferred

  • Minimum of one year experience in authorization role
  • Experience using agency software for electronic medical records
  • Experience or exposure to Practice Management Software
  • Experience working with medical terminology. 
  • Experience working in a growing organization 



  

Empower Behavioral Health and Circle of Care provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. 


This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.