naviHealth, Inc. Associate Authorization Resolution Specialist in United States
naviHealth recognizes the vital role providers play in enhancing our service delivery to the member. A highly engaged provider network is critical to ensure members receive the right care at the right place for the right amount of time. The Associate Authorization Resolution Specialist is an entry level position, working under the direction of the Manager, Authorization Resolution to ensure the integrity of our authorization data and resolve authorization issues timely. Additionally, the incumbent will identify root causes of authorization issues and engage with internal and external stakeholders to implement permanent resolutions.
Serve as initial point of contact for telephone or e-mail inquiries regarding provider authorization issues.
Work with a multidisciplinary team to track and resolve issues associated with claims denials and authorization data load rejections to health plans.
Ensure the data integrity of all authorizations sent to naviHealth’s health plan partners.
Resolve issues from reconciliation and exception reporting and provider contact.
Perform other duties and responsibilities as required, assigned, or requested.
Bachelor’s degree in a related field or any combination of education and experience, which would provide an equivalent background
1 - 3 years health care experience in claims, provider data, authorizations and project management experience
Experienced in managed care, health plan operations in provider contracting, customer service, or provider relations a plus
Resolves issues from reconciliation and exception reporting and provider contact
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Intermediate Excel, Access, other data management or data modeling skills a plus but not required
SQL experience a plus
Self-starter; capable of managing multiple projects at once
Work Conditions and Physical Requirements
Ability to establish a home office workspace
Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard time period
Ability to communicate with clients and team members including use of cellular phone or comparable communication device
Ability to remain stationary for an extended time period (1 – 2 hours)
Being a pioneer in post-acute management and care transitions with over 19 years of experience, naviHealth is uniquely positioned to manage patients, improve clinical and financial outcomes, and share risk with payors and providers. We provide clinical service support alongside proprietary technology and advisory solutions that empower health systems, health plans and post-acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes.
Rooted in respect
Guided by purpose
Devoted to service
Energized by impact
The above statements are intended to describe the general nature and level of work performed by colleagues assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications. naviHealth reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
naviHealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other protected status under applicable laws and will not be discriminated against based on disability.
Requisition ID: 2021-5910
Location Type: Field / Office / Virtual: Virtual (Home Office)