Insurance Authorization Specialist

3 weeks ago


West Allis, United States State of Wisconsin Full time

**Duration**: 3 Months contract with possible extension.

Maintains, confirms and secures referrals, authorization, or pre-certifications required for patients to receive physician or medical services. Verifies the accuracy and completeness of patient account information.
Maintains database of payer authorization requirements.

**Major Responsibilities**:

- Contacts insurance carriers to obtain benefit coverage, policy limitations,
- authorization/notification, and pre-certifications for patients. Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process,
- Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
- Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
- Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance.
- Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status. May notify ordering providers if authorization/certification is denied.
- May coordinate scheduling of patient appointments, diagnostic and/or specialty
- appointments, tests and/or procedures.
- Maintains files for referral and insurance information, and enters referrals into the system.
- Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre
- authorization and a list of current accepted insurance plans.

**Education Required**:

- High School Graduate.

**Experience Required**:

- Typically requires 1 year of experience in providing customer service that includes
- experiences in patient accounts, third
- party payer plans, accounts receivable/collection processes, and medical clinic processes and workflow.

**Knowledge, Skills & Abilities Required**:

- Knowledge of third-party payers and pre-authorization requirements,
- in the patient referral / precertification / authorization processes.
- Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic
- mail, physician practice management, and electronic medical records systems.
- Strong analytical, prioritization and organizational skills.
- Ability to work independently with mínimal supervision and to manage multiple priorities.
- Exceptional communication and interpersonal skills with a high degree of diplomacy and tact. Ability to effectively communicate with a variety of people under stressful circumstances.

**Physical Requirements and Working Conditions**:

- Exposed to a normal medical office environment.
- Sits the majority of the workday.
- Operates all equipment necessary to perform the job.

**Job Type**: Contract

Pay: $25.00 - $28.00 per hour

Weekly day range:

- Monday to Friday

Application Question(s):

- Are you comfortable to work on 3 Months contract with possible extension?

**Experience**:

- Insurance verification: 1 year (required)

Ability to Commute:

- West Allis, WI 53227 (required)

Work Location: In person



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