Authorization Specialist

Summary: Individual who is highly skilled in ensuring that patients receive the proper preauthorization for the Insurance companies and their third-party authorizations companies. This individual will address and rectify rejected preauthorization to the best of their ability.

Essential Job Responsibilities:

1. Assist medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
2. Develop and implement prior authorizations work flow, policies, and procedures.
3. Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
4. Review accuracy and completeness of information requested and ensure that all supporting documents are present.
5. Receive requests for pre-authorizations and ensure that they are properly and closely monitored.
6. Submit medical records to insurance carriers to expedite prior authorization processes.
7. Manage correspondence with insurance companies, physicians, specialists and patients as required.
8. Look through denials and submit appeals in a bid to get them approved from insurance companies.
9. Create notes in patient’s account to ensure the pre-authorization information is properly updated in them
10. Always secure the patient’s demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulation.
11. Evaluate portions to be paid by the customer and document that in the account. Notify customers of deductible and co-insurance due.

Education Requirements: High school diploma or equivalent from two-year college or technical school or six months to one-year related experience and/or training preferred.

Experience Required: Typically requires 0-2 years of related experience.

Performance Requirements (Knowledge, Skills & Abilities):

Knowledge:

• Knowledge of medical and insurance terminology, specifically collecting co-pays & co-insurance and of the services provided by the practice;
• Knowledge of basic math skills;

Skills in:

• Establishing and maintaining effective working relationships with other employees, patients, organizations, and the public; and
• handling large patient volumes, registering patients for multiple physicians, and working under pressure.

Ability to:

• communicate in writing, over the telephone, and in person with office staff and patients;
• recognize, evaluate, solve problems, and correct errors;
• multi-task and stay focused on the immediate task;
• interact with patients, medical and administrative staff, and the public effectively;
• elicit appropriate information to route calls and assist persons with their needs and;
• prevent, calm, or defuse irate or upset patients by working with them to identify concerns and find assistance for them.

Work Environment: Position is in a well-lighted, temperature-controlled office environment.