Clinical Authorization Specialist- Workers Compensation (Remote)

Upstream Rehabilitation - Kent, WA

Full-time - Mid Level

Remote - Kent, WA

Administrative and Support Services

About the position

The Clinical Authorization Specialist for Workers Compensation is a remote position responsible for managing the authorization process with insurance companies and third parties. This role ensures that all necessary verifications and authorizations for patient treatment are completed accurately and timely, supporting the overall mission and values of Upstream Rehabilitation. The specialist will also supervise both direct and indirect reports, ensuring effective communication and collaboration with payors and internal teams.

Responsibilities

• Reviews patient electronic health record and verification of benefits completed by 3rd party (Guidehouse) for all patients.
• Communicates with payors to obtain any clarifications on the verification of benefits.
• Maintains positive payor relationships.
• Works with payors to obtain prior- and re-authorizations as required by the patient plan of care and payor.
• Handles documents and records related to patient insurance benefits and required authorizations and submits to payors accordingly.
• Manages requests to ensure prior authorizations are submitted within timeline guidelines.
• Follows up with payors to check the status of previously submitted authorizations.
• Processes authorization appeals for the appropriate patients.
• Works with back-end revenue cycle to understand and address authorization issues that may lead to downstream denials or write-offs.
• Reverifies insurance and authorization if needed for the crossover process (EOY insurance changes).
• Handles patients that have a change in payor during their plan of care as indicated by the payor overlap form submitted by an Office Coordinator.
• Maintains a working understanding of insurance benefits and seeks assistance as necessary.
• Determines and documents the amount to be collected from each patient visit (copay, co-insurance, payment towards deductibles).
• Monitors reports and dashboards related to patient benefits / authorizations and works with clinic and business office teams to improve results.
• Demonstrates communication skills that aligns with Mission, Vision and Values.
• Supports organizational changes and required clinic changes.
• Other duties as assigned.

Requirements

• Experience in healthcare authorization processes, particularly in workers compensation.
• Strong understanding of insurance benefits and verification processes.
• Excellent communication skills, both verbal and written.
• Ability to manage multiple tasks and prioritize effectively.
• Proficiency in using electronic health record systems and related software.

Nice-to-haves

• Experience with revenue cycle management.
• Knowledge of medical billing and coding practices.
• Familiarity with various insurance payor systems.

Benefits

• Annual paid Charity Day to give back to a cause meaningful to you
• Medical, Dental, Vision, Life, Short-Term and Long-Term Disability Insurance
• 3-week Paid Time Off plus paid holidays
• 401K + company match