Authorization Specialists help our practice to be successful by excelling at obtaining insurance authorizations for procedures. This entails having a strong background in obtaining authorizations, understanding and have the ability to navigate through the challenging environment of healthcare insurance verification and approvals, as well as ultimately scheduling the patient for the procedure. Excellent customer service skills are necessary to serve the needs of the payer, the provider and the patient.
What You'll Do:
- Complete, submit, and track pre-procedural authorization requests with commercial. government payers (Medicare, HMOs, PPOs,) and Work Comp via portals, phone, and fax.
- Assist billing department to obtain retro authorization for services that were rendered (either office visits or surgical procedures). This may include hospital procedures, office visits or outpatient surgical procedures.
- Resolves pre-certification, registration and case-related concerns prior to a patient's appointment.
- Verify patient insurance eligibility, benefits, and coverage requirements prior to appointments or scheduled surgeries
- Work on daily list for designated physician(s) and follow up with office via fax to determine patient coverage, coordination of benefits, etc.
- Respond to phone calls from internal doctor teams, check in/check out staff, or primary care physician offices and respond accordingly.
- Review daily schedules to verify that procedures have been through pre-authorization process. Any new additions to the schedule will require coordination of benefits and follow up with the respective department.
- Review faxes for newly scheduled surgery and conduct insurance verification and obtain proper authorizations.
- Daily review of internal practice management system for requests from doctor’s team offices. This may include rescheduled surgeries, rescheduled office visits, etc.
- May explain benefits information to patients who arrive to visit and may not understand their portion of the bill (co-pay, deductibles, etc.).
- Data enter pre-authorization deductibles, co-insurance, out-of-pocket and related information in to patient demographic record.
What you'll need:
- Must have a High School Diploma or equivalent.
- Minimum 1 year of experience completing prior authorizations.
- Knowledge of health insurance concepts (i.e., HMO, PPO, etc.). Experience in a healthcare environment.
- Proficient computer skills. Exceptional customer service skills. Proficient and accurate data entry skills.
- Ability to multi-task, prioritize work and make sound judgments. Ability to remain patient during long periods of telephonic hold times.
- Other duties as assigned as necessary and may vary at times, as needed, by your immediate supervisor or as directed by the company.
- Prolonged sitting. Repetitive motion (data entry), and phone contact.
- Movement between locations to support the pre-authorization process as needed.
Job Type: Full-time
Pay: From $20.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
