Authorization Specialist
Authorization Specialist is responsible for obtaining prior authorizations for all treatment by successfully completing the authorization process with all commercial, automobile and workers compensation payers.
RESPONSIBILITIES
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Review chart documentation to ensure patient meets medical policy guidelines
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Prioritize incoming authorization requests according to urgency
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Obtain authorization via payer website, fax or by phone and follow up regularly on pending submission
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Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
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Initiate appeals for denied or modified authorizations
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Respond to clinic questions regarding payer medical policy guidelines
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Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
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Other duties as assigned
KNOWLEDGE, SKILLS, AND ABILITIES
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Knowledge of treatment authorization and its direct impact on the practice's revenue cycle
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Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
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Proficient use of CPT and ICD-10 codes
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Excellent computer skills including Adobe, Excel and Internet use
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Detail oriented with above average organizational skills
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Plans and prioritizes to meet deadlines
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Excellent customer service skills; communicates clearly and effectively
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Ability to efficiently manage and prioritize time-sensitive tasks that arise
EDUCATION/EXPERIENCE REQUIRED
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High School Diploma or GED
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2 years medical prior authorization experience preferred
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2 years experience with MD providers - Orthopedics & Pain preferred.
Job Type:
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Full-time
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Monday to Friday
Benefits:
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401(k) matching
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Health insurance
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Paid time off
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Paid Holidays
Background Check Requirement: Employment is contingent upon the successful completion of a background check, which may include verification of employment history, education, criminal records, and other relevant information as permitted by law
