Authorization Specialist

JOB TITLE: Authorization Specialist

 

GENERAL SUMMARY OF DUTIES:

Responsible for obtaining managed care authorizations and verifying patient insurance benefits.  Analyzing utilization data from health plans' claims as required.  Maintains optimal patient, referring physician and insurance company satisfaction.

 

SUPERVISION RECEIVED: Office Manager

 

ESSENTIAL FUNCTIONS:  

• Obtaining required referrals and authorizations prior to services via phone, fax, on-line, etc.
• Review office schedules daily for patients requiring authorizations, referrals, pre-notification, and insurance eligibility verification.
• Obtaining retro-authorizations or updating existing authorizations in a timely manner.
• Inputting/updating authorization information into EHR.
• Updates the patient account with details of the insurance verification.
• Identifies deductibles, co-pays, and self-pay accounts.  Identifies large dollar DME accounts.
• Notifying the appropriate staff members if treatment or service is denied.
• Coordinating with the Financial Counselor necessary information for patient discussions.
• Working with the provider if a peer-to-peer review is necessary or requested by the payer.
• Keeping up-to-date on third party payer authorization requirement information.
• Re-verify all patients monthly for active, current insurance.
• Assist Collection staff with account questions when presented.
• Participates in professional development efforts to ensure currency in health care practices and trends.
• Perform other duties as assigned.

 

EDUCATION:  High School, with 1-2 years experience in healthcare insurance billing and verification, collections and/or authorizations. 

 

KNOWLEDGE: 

• Knowledge of clinic policies and procedures. 
• Knowledge of managed care contracts and utilization.
• Knowledge of computer systems, programs and spreadsheet applications. 
• Knowledge of medical terminology.
• Knowledge of CPT/ICD-9

 

SKILLS:

• Skill in gathering and reporting claim information. 
• Skill in solving utilization problems. 
• Skill in written and verbal communication and customer relations.

 

Benefits:

• Comprehensive health, dental, and vision insurance
• Health Savings Account with an employer contribution
• Life Insurance 
• PTO
• 401(k) retirement plan with a company match
• And more! 

 

 Equal Employment Opportunity & Work Force Diversity

Our organization is an equal opportunity employer and will not discriminate against any employee or applicant for employment based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical or mental disability, medical condition, parental status, sexual orientation, veteran status, genetic testing results or any other consideration made unlawful by federal, state or local laws.  This practice relates to all personnel matters such as compensation, benefits, training, promotions, transfers, layoffs, etc.  Furthermore, our organization is committed to going beyond the legal requirements of equal employment opportunity to take positive actions which ensure diversity in the workplace and result in a multi-cultural organization.