JOB SUMMARY
The Authorization Specialist is responsible for the day-to-day processes to verify patient eligibility and
obtain authorization for all exams scheduled to ensure timely payments from all accepted payer. The
typical daily work load consists of the following: eligibility investigations via phone and online web
portals, obtaining authorizations, collecting supporting clinical data from patients and/or referring offices and
updating all information.
RESPONSIBILITIES
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Manage the predetermination, authorization, and referral requirements of each health plan and meeting the requirements prior to the delivery of services.
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Contacts patients and/or referring offices for updated insurance information, medical records and/or additional clinical data to ensure that no more than 5% of all exams end up in pending clinical.
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Cross reference daily schedule and work queue to ensure that all scheduled exams are authorized forty-eight (48) hours prior to the date of service.
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Cross reference daily schedule and work queue to ensure that all same day add-ons are authorized prior to the completion of the exam; other payers must be authorized within twenty-four (24) hours following the completion of the exam.
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Work with each health plan to provide medical records and/or additional clinical data to ensure that 99% of all completed exams are approved for payment.
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Communicate and coordinate effectively with internal departments to ensure patient insurance information is accurate and updated.
LINE OF AUTHORITY
Reports to the Administrative Director Employee
QUALIFICATIONS
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Current knowledge of medical terminology, insurance authorization and verification.
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Knowledge of ICD-Codes/CPT preferred.
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Strong technical skills (Word, Excel, Acrobat or similar product).
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Successful completion of or the ability to successfully complete any state required continuing education requirements.
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Excellent verbal and written communication skills and strong interpersonal skills.
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Ability to work in a fast paced setting.
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Knowledge of regulatory requirements at the federal, state and local levels, as well as knowledge of Agency policies and procedures.
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At least 21 years of age.
