Authorization Pre-Access Specialist

1 month ago


New York, United States Medix Full time

Key Responsibilities:
Insurance Verification:

Review patient insurance information to determine coverage and eligibility for surgical procedures.
Contact insurance companies to obtain pre-authorization for surgeries, ensuring all necessary documentation and information are provided.
Documentation Management:

Maintain accurate and up-to-date records of authorization requests, approvals, and any pending issues.
Document all communication with insurance companies, patients, and healthcare providers.
Coordination and Communication:

Communicate with patients to inform them of their insurance coverage and any out-of-pocket costs they may incur.
Work closely with surgeons, nurses, and other healthcare providers to ensure all pre-surgical authorizations are completed in a timely manner.
Notify relevant departments of authorization status to facilitate scheduling and preparation for surgeries.
Problem-Solving:

Address any issues or delays in the authorization process, seeking alternative solutions or escalating as necessary.
Assist patients with any questions or concerns regarding their insurance coverage and the authorization process.
Compliance and Policies:

Ensure compliance with all healthcare regulations and insurance policies regarding pre-surgical authorizations.
Stay informed about changes in insurance policies and procedures that may affect the authorization process.
Qualifications:
Education:

High school diploma or equivalent required.
Associate or Bachelor's degree in healthcare administration, business, or a related field preferred.
Experience:

Previous experience in medical billing, insurance verification, or a related healthcare role preferred.
Familiarity with medical terminology and surgical procedures is advantageous.
Skills:

Excellent communication and interpersonal skills.
Strong organizational and multitasking abilities.
Proficiency in using medical billing software and electronic health records (EHR) systems.
Attention to detail and accuracy in managing documentation and information.



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