Authorization Specialist

Reports to:       Revenue Cycle Manager

Position Summary

            Obtains prior authorization on all scheduled diagnostic testing and procedures ordered by group physicians, both in office and off-site, as required by insurance to secure payment. Documents appointment schedule and EMR in effective and detailed manner.

Job Responsibilities

·         Maintains a current knowledge of insurance requirements for prior authorization

·         Understands which primary and secondary participating insurances require authorization

·         Demonstrates knowledge of CPT and ICD-10 codes relevant to the practice

·         Monitors all clinic testing schedules to ensure prior authorization is obtained as required by carrier; reviews schedules frequently for changes

·         Utilizes online or telephone tools to obtain authorization numerous days in advance of appointment

·         Submits timely authorization requests and ensures required documentation is submitted

·         Maintains accurate EMR documentation with reference or authorization numbers, dates, initials

·         Obtains and documents deductible and copay information required for testing.

·         Retro reviews hospital procedures (via pMD or otherwise) to ensure authorizations obtained in timely manner.

·         Maintains open and timely communication with all clinical staff on all prior authorization issues

·         Maintains a friendly and professional manner with coworkers, patients, insurance carriers, etc.

·         Communicates with patient regarding insurance problems and authorization delays, rescheduling patient if necessary

·         Utilizes patient scheduling and chart software in proficient manner.

·         Follow confidentiality and security rules when providing patient information; follows HIPAA guidelines.

·         Adhere to OSHA guidelines and participate in safety program

·         Perform any other services deemed reasonable by physician or team lead.

Qualifications

            Education and Experience:  High school diploma or equivalent. A minimum of one year’s experience with insurance and medical billing, specifically with authorizations. 

            Knowledge:  Modern operational methods inherent to a medical practice; clerical equipment, operations and processes; must have basic understanding of medical terms and abbreviations; usage of computer systems; patient confidentiality/HIPAA regulations.

            Abilities:  Able to multi-task in fast-paced environment, be detail-oriented; is well-organized; demonstrate moderate computer skills, utilize proper telephone etiquette; maintain professionalism in difficult situations; establish and maintain cooperative relationships with staff members; create a responsive, caring environment for patients; respond promptly to physicians’ directions; maintain medical records in a concise and accurate manner; react quickly in emergency situations; recognize and prevent possible safety hazards; exercise independent judgment; communicate clearly and concisely. Fosters a positive working environment that is responsive to patient needs.

Note:  This description indicates in general terms the type and level of work performed and responsibilities held by the employee(s).  Duties described are not to be interpreted as being all-inclusive.