Authorization Specialist

SCHEDULE: Monday–Friday, 8:00AM-5:00PM, On-Site

POSITION SUMMARY
All Together Recovery LLC (ATR), provides multiple levels of ASAM SUD/BHSO care,
including recovery housing, education, job training, employment, and other recovery related
extensions to the family in for-profit and non-profit environments. The Authorization Specialist
is responsible for obtaining, tracking, and maintaining insurance authorizations for patient
services to ensure timely access to care and proper reimbursement. This role serves as a key
liaison between clinical teams, insurance payers, and administrative staff, ensuring compliance
with payer requirements and minimizing authorization-related denials or delays.

KEY PERFORMANCE INDICATORS (KPIs)
The Authorization Specialist's performance will be evaluated based on the following measurable
outcomes:
Authorization & Utilization Management

• Obtain initial insurance authorizations for assigned levels of care (e.g., 3.1 & 3.5

residential, PHP, IOP, outpatient) by submitting authorization requests to Medicaid and
commercial payers via portals, fax, or phone.
o KPI: 100% of initial authorization requests submitted within 24-48 hours of
admission.

• Track authorization start/end dates, approved days, and service limitations.

o KPI: 100% of authorizations added to the Billing/Authorizations calendar daily.

• Communicate authorization determinations, extensions, and denials to clinical, medical, and billing teams.

o KPI: 100% of determinations communicated interdepartmentally via email daily.

• Coordinate with clinical and medical staff to gather required documentation for

concurrent reviews.
o KPI: Send reminder emails to teams within 48 hours with 100% accuracy.

• Monitor census and authorization expirations to prevent lapses in coverage.

o KPI: 100% of determination dates added to the Authorization/Census Tracker.

• Maintain accurate authorization records in the EHR and payer portals.

o KPI: 100% of authorization determinations added to the EHR daily.

• Follow up on pending authorizations and escalate urgent cases affecting patient care to the Business Office Manager.

o KPI: 100% of pending authorizations followed up if needed.
o Escalation effectiveness: Urgent authorization issues escalated same business day
when impacting patient care.

• Assist with appeals and retro-authorizations related to authorization denials.

o KPI: 100% of appeals and retro-authorizations submitted within 5 days of
determination.
o Authorization-related denial rate: 5%.
o Appeal success rate: 75% for appealed authorization denials.

• Ensure compliance with payer guidelines, state regulations, and internal policies.

o KPI: 100% compliance with payer guidelines and internal policies.

• Scan, upload, and organize authorization correspondence and payer communications.

o KPI: 100% of all authorization documentation uploaded and in patient charts.
Billing & Claims Management

• Cross train with initial claim submission and claim denial management to ensure

continuity of care for patients.
o KPI: Cross train in billing services within 30 days of hire.

• Support coverage during staffing shortages, downtime, or high-volume periods, within scope of training.

o KPI: 98% accuracy on tasks performed while providing cross-coverage.

• Develop working knowledge of billing workflows, claim submission processes, and

payer requirements related to authorized services.
o KPI: Successfully perform designated billing/claims support tasks with minimal
supervision within 90 days.
Miscellaneous & Other Duties

• Assist with answering incoming phone calls and direct to appropriate departments

0 KPI: 100% of phone calls answered

• Assist with other duties as assigned by Business Office Manager

ADDITIONAL PERFORMANCE EXPECTATIONS:
These align with the qualitative aspects of the role but should be reflected in regular evaluations:

• Demonstrates leadership and integrity in all interactions.
• Models servant leadership and fosters a culture of recovery and respect.
• Engages in continuous quality improvement for daily office operations.

SUPERVISORY RESPONSIBILITIES:
This position has no supervision responsibilities.
117 Letton Drive, Danville, Kentucky | P a g e
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BACKGROUND/EDUCATION:

• The applicant must have a minimum of a high school diploma or GED.
• Minimum of 2-3 years' experience in SUD authorizations, utilization review, or

behavioral health billing. An associate degree is preferred but not required.

• Experience working in behavioral health field strongly preferred.
• Previous experience working with KIPU, CollabMD, Availity, KYMMIS, and payer

portals strongly preferred.

QUALIFICATION REQUIREMENTS:
Must have knowledge of medical privacy and confidentiality (Health Insurance Portability and
Accountability act (HIPAA); computer applications/software to include Microsoft Office
programs/MS outlook (e-mail), and internet familiarity, along with Dropbox and EHR is
preferred.
Experience working with individuals and families who have various mental, behavioral, and
substance use conditions.

SKILLS REQUIRED:

• Must have the knowledge, skills, and abilities to perform the essential functions of the job.
• Must have excellent customer service skills.
• Must have organizational skills with attention to detail.
• Must have strong communication skills both verbal and written
• Maintain effective interpersonal relationships.
• Must have the ability to work independently, and in a demanding and busy environment.
• Must have the ability to multitask and have a proficient handle on completing tasks

within an assigned timeframe.

WORKING CONDITIONS:
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to sit, stand, bend, reach overhead and lift to 50 pounds; travel outside the office and/or attend meetings both during and after normal work hours, both at and away from the worksite. Exerting up to 50 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body, Role involves walking or standing for brief periods of time. Requires about 3 hours of sitting and no more than 5 hours of standing or walking in an 8-hour workday.

Environmental Conditions:
The employee will work in an office setting with central heating and air. Some travel between
facilities may be required.
Mental Demands:
There are several daily deadlines associated with this position, which may cause significant
levels of stress for some individuals. The position will work with clients, staff, and family
members on a variety of issues.

WORK EXPECTATIONS:
1. Must be able to work well with other staff and clients.
2. Some travel required.
3. Minimum of 40 hours per week.