Director of Benefits & Authorizations

FORTA’S MISSION:

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.  

• Ensure compliance with the company’s quality assurance policies and project delivery procedures as well as federal and state regulations, and that commercial and state payer guidelines are followed
• Responsible for obtaining and recording eligibility and benefit information for patients receiving services and initiates the admission notification and authorization process in a timely manner 
• Communicates to resolve patient access and quality service matters and demonstrates an ability to lead more complex processes related to insurance verification, authorization, and financial clearance
• Have an in depth understanding of eligibility and benefits processes and be able to effectively use E&B information to submit prior authorization and single case agreement requests
• Create effective strategies for handling payor requests and exceptions with regards to prior authorizations, single case agreements, and billing
• Help to identify and creatively address project problems, issues and risks, including facilitating trade-off decision discussions, ensuring all key stakeholders are identified and engaged. 
• Hire, onboard and manage a team of operations and billing professionals who deliver fast and accurate results
• Sets performance goals for assigned teams, monitors their work performance and attendance
• Ensures that staff is adequately trained to meet work volumes and identifies deficiencies to ensure employees receive additional training as necessary
• Responsible for proactive administration of reviewing and processing all benefit eligibility and authorization data to payors are expedited and deadlines are met on time
• Coordinate with multiple disciplines and departments while integrating their tracking systems into the overall project design
• Develop an understanding of the entire Forta client lifecycle and ensure the information required to submit authorizations and bills for each client is collected and cataloged by every team involved in the  process, including the intake, clinical, credentialing, billing, and tech teams
• Create and maintain a product lifecycle program visualization dashboard, from high-level business view to project-specific views 
• Communicate project status and project and business risks effectively to department leader
• Evaluate and implement technology solutions that enhance the efficiency and accuracy of insurance verification and authorizations processes
• Continuously review and refine processes to optimize workflow and reduce errorsUtilize data analytics to track and report on key performance indicators (KPIs) related to insurance verification and authorizations
• Provide insights and recommendations based on data trends to improve operational performance

• Bachelor’s degree and 7 years of work-related experience; previous ABA experience preferred
• Advanced knowledge and ample experience in behavioral health insurance verification, authorizations and financial clearance with a broad range of providers
• Must have experience working with various insurance companies, and extensive knowledge of insurance verification, authorizations, and billing for various types of commercial and governmental plans
• Excellent project management skills with the proven ability to yield results
• Candidates should be self-motivated, independent, detail oriented, responsible team player and exhibit exceptional relationship management skills
• Mange through obstacles, addressing roadblocks and updating stakeholders and that team members are meeting deadlines
• Proven ability to influence and communicate complex ideas effectively, verbally and in writing
• Proven ability to significantly contribute toward or lead operation initiatives with a results-oriented approach

YOU NEED IT?  WE GOT IT!:

Benefits (for qualifying employees): Medical, Dental, Vision, Retirement, Flexible Spending Account, Dependent Care Account, and more!

Flexible Time Off (for qualifying employees): Unlimited time off! Great for personal, sick, and mental health days.

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!  

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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.