Authorizations Specialist

2 months ago


Wilmington, United States EmergeOrtho Full time
Description

Description

EmergeOrtho is committed to being the trusted leader in innovative, quality-focused comprehensive musculoskeletal care. With offices across North Carolina,the Authorizations Specialist is responsible for procuring effective surgical authorization information for patient surgical services from appropriate insurance carriers.

Requirements

Educational Requirements:
  • High school diploma or equivalent is required;
  • A minimum of 3 to 5 years of experience in a medical office environment is preferred
Qualifications and Experience:
  • Prior medical assistant experience
  • Strong customer service skills
  • Ability to positively interact with providers, staff, patients and their family members.
  • Ability to work in a fast-paced environment
  • Ability to prioritize and handle multiple tasks and demands
  • Sound interpersonal skills
  • Strong organizational skills
  • Strong computer skills
  • Obtain authorizations from various insurance companies
  • Contact patients to schedule appointments for study/Injections and for results
  • Complete MRI screening form with patients
  • Document all appointments and times in EMR and Athena
  • Scan and drop MRI/Visco related documents
  • Submit to insurance for benefits and coverage details
  • Collect any patient financial obligations
Responsibilities include, but are not limited to:
  • Make calls to insurance companies for necessary surgical authorization of services for patient appointments.
  • Utilize online services from insurance companies to obtain surgical authorizations and/or gather information regarding patients' coverage for services.
  • Process all items for review in the practice management system and assigned to the department and/or third party software.
  • Handle all calls and/or written inquiries regarding appointment service surgical authorizations through resolution.
  • Research, correct and re-file any denied or rejected surgical authorization to maximize reimbursement.
  • Ensuring surgical authorizations are up to date, entering surgical authorizations into EHR, scanning and linking surgical authorizations to the patient's chart.
  • Extensive scheduling coordination with the surgery department, specialist and ancillary departments is needed.
  • Contact patient insurance provider to obtain authorization and confirm eligibility status for the surgery and verify patient's insurance coverage to include deductibles, out of pocket maximums, etc.
  • Using information obtained from insurance provider, calculates patient's payment amount to be paid to EmergeOrtho prior to surgery.
  • Document all information obtained in the practice management system to adequately relay said information to all staff and/or third party software.
  • Report rules, changes and other information affecting surgical authorizations to the Medical Records Supervisor.
  • Print reports from the practice management system to facilitate surgical authorization for appointment services for previously scheduled patients and patients added on.
  • Participate in educational and training opportunities to maintain current knowledge of payment policies Organize electronic patient records based on referral status.
  • Fills in for other account representative positions as needed.


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