Forta is clearing the path to quality healthcare by delivering the best possible outcomes with the utmost convenience. 1 in 36 children [CDC, 2023] is diagnosed to be on the autism spectrum. Currently, autism support via Applied Behavior Analysis (ABA) is difficult to access and the delivery model must be expanded to provide earlier access to families.

Forta is not only providing ABA services to our clients, but we’re also improving the future of the ABA experience for families by creating software and predictive algorithms that elevate clinicians to work smarter by surfacing the latest and most relevant case data. We are working diligently to continuously improve the patient journey and deliver personalized care by applying smart technology and investing in the growth of our world-class team.

As the Medical Authorization Team Lead at Forta, you will play a pivotal role in streamlining the prior authorization and single case agreement processes with insurance companies. Your leadership skills will be instrumental in ensuring the efficiency and accuracy of these critical functions, contributing directly to the success of our mission. Additionally, you will be responsible for managing a team of 5-10 associates, providing training, coaching, and overseeing their performance to ensure they meet metrics and stay on track.

Responsibilities:

Team Management:
Lead and manage a team of 5-10 associates responsible for prior authorization tasks.
Provide training and coaching to associates on their responsibilities and tasks.
Monitor, assess, and improve team performance to ensure they meet or exceed metrics and stay on track daily.
Foster a collaborative and supportive team environment.
Prior Authorization Administration:
Initiate and manage the prior authorization process with various insurance companies.
Review patient medical records, treatment plans, and other relevant documentation to gather necessary information for authorization requests.
Collaborate with healthcare providers and other stakeholders to obtain additional documentation or clarifications as needed.
Ensure that all prior authorization forms and supporting documents are accurately completed and submitted within established timelines.
Single Case Agreement Administration:
Research and identify insurance companies that require single case agreements for specific treatments or services.
Liaise with insurance companies to negotiate and establish single case agreements.
Coordinate with the internal team to ensure that all necessary information is included in the billing documentation to comply with single case agreement requirements.
Documentation and Record-Keeping:
Maintain comprehensive and organized records of prior authorizations and single case agreements.
Ensure all billing-related documentation is complete, accurate, and compliant with legal and regulatory requirements.
Prepare and submit necessary reports, statistics, and analysis related to billing and authorization activities as requested.
Communication and Collaboration:
Build and maintain relationships with internal departments, external agencies, and insurance companies.
Collaborate with internal teams for seamless operations.
Identify areas for process improvement and implement solutions to enhance efficiency and effectiveness.

Requirements:

Bachelor's degree is required, specialization in healthcare administration, business administration, or a related field is preferred but not required.
Knowledge of medical billing procedures, including insurance billing, coding, and claim submission processes, and experience in medical billing, specifically in prior authorization management and single case agreements are a plus
As this is a fully remote position, you must have a reliable internet connection and be able to provide your own computer and equipment.
Strong attention to detail and ability to manage multiple tasks simultaneously.
Excellent organizational, communication, and interpersonal skills.
Proficiency in using Google Workspace.
Ability to navigate complex systems and processes.
Ability to work independently and prioritize tasks to meet deadlines.
Maintaining confidentiality and adhering to ethical standards in handling sensitive patient information.

Apply Today!

We are looking for you! A driven, innovative, client-focused individual to join our team as we innovate the care and tools available to neuro-diverse families. If this position sounds like the opportunity you have been searching for, we want to speak with you!

We look forward to working with you!

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Forta is a Drug-Free Workplace/ EO employer – M/F/Veteran/Disability.

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