Authorization Specialist

4 weeks ago

Goshen, United States WMC Health Network Full time

Summary:

The Authorization Specialist is responsible for performing complex clerical procedures related to verifying insurance information and obtaining authorization for hospital procedures and tests as well as office diagnostic testing in accordance with established rules and procedures, specified time frames and regulatory requirements. The employee processes clinical information in a timely, efficient manner to prevent treatment delays and to avoid denials from third party payers and maintains confidentiality of patient information.

Responsibilities:

  • Serves as liaison between physicians, office staff, patients and insurance carriers regarding the authorization process.
  • Collects and reviews for accuracy patient demographic and insurance data as part of the authorization process.
  • Collects and submits all documentation and diagnosis needed for Authorizations.
  • Advises physicians, Oncology RN's, Billing manager and practice Administrator of problems with insurance authorizations and resubmits requests with additional or revised information as needed.
  • Notifies provider of the need for peer-to-peer reviews for problem cases which have been initially denied authorization for services and will assist with the arrangement of same.
  • Provides daily follow-up with the authorization departments of the various insurance carriers for an update of the status of the various authorization requests to ensure optimum delivery of services.
  • Adheres to the policy to prevent denials or patient delays.
  • Performs eligibility checks on insurance payer's internet websites and RTE.
  • Effectively utilizes automated systems to perform work assignments.
  • Continually reviews diagnostic testing schedules at multiple locations to capture any changes, i.e., add on testing to the various schedules.
  • Reviews daily what authorizations for procedures have processed and what is outstanding.
  • Logs in deliveries of medications received from Specialty pharmacies on a daily basis and notifies appropriate person via EMR and in person.
  • Performs other tasks as assigned.
Qualifications/Requirements:
Experience:

1-3 years of experience in the health care field is required. Previous experience with the pre-authorization process required. Experience in the field of oncology preferred.

Education:

A high school diploma or equivalency required.

Licenses / Certifications:

N/A

Special Requirements:

N/A

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