Authorization Specialist

POSITION OVERVIEW:

An authorization specialist works for the authorization department lead under the oversight of the practice

manager. Daily tasks will include obtaining authorizations for physical and occupational therapy and other ancillaries as necessary. This role will also actively interact with medical staff and patients.

ESSENTIAL FUNCTIONS:

· Monitor Therapy EMR and navigate payer authorization sites efficiently to authorize scheduled procedures to include initial evaluations, returning visits, DME and other items needing authorization with insurance. Verify eligibility and benefits for all procedure codes.

· Pre-collect payment for therapy and other procedures as required by department

· Review Patient’s medical history and insurance coverage for approval, Document work processes as required

· Contact referring physicians for additional information as needed, coordinate processes and route all paperwork as required to meet physician and regulatory requirements

· Input new patient information and update information in our system

· Document in EHR prior authorizations information obtained such as a number of treatments authorized, length of time treatment is authorized, authorization numbers and insurance company contact information.

· Assist with clerical tasks as needed

· Must be able to recognize and respond appropriately to urgent /emergent situations.

· Follow all written protocols and procedures of the clinic including the OCC handbook and all department policy and procedures

· Demonstrate courtesy and helpfulness toward patients and / or their families.

· Ensure efficient telephone communication when required

· Work as a team member within the authorizations department and all other departments

REQUIRED QUALIFICATIONS AND SKILLS:

· Medical terminology, ICD-10 and CPT coding knowledge

· Knowledge of contracted insurance plans and procedures

· Solid computer and phone skills

· Strong organizational and interpersonal skills

· Ability to prioritize responsibilities and multi-task efficiently and effectively

· Adaptability to different plan and lien requirements

WORKING CONDITIONS:

Typical business office environment

· Possibility of local travel

· Constant viewing of computer monitor, mousing and typing

· Frequent standing, walking and sitting

· Frequent stooping, lifting, carrying and pushing/pulling 10 pounds or more

· Occasionally lift and/or move up to 50 pounds

· Specific vision abilities required by this job include close vision, color vision, peripheral vision, and ability to adjust focus

· Hours of business are Monday – Friday from 8:00 a.m. to 5:00 p.m. Must be able to work early, late and long hours, as needed, to meet the essential functions of the job