Authorization Specialist

2 months ago

Valhalla, United States Westchester Medical Center Full time
Job Summary:

The Authorization Specialist is responsible for performing complex clerical procedures related to verifying insurance information and obtaining authorization for inpatient admissions and specialized clinical procedures and treatments in accordance with established rules, procedures, specified time frames, and regulatory requirements. The Specialist processes clinical information in a timely manner to prevent treatment delays and to avoid denials from third party payers and maintains confidentiality of patient information.

Responsibilities:
  • Enters and retrieves information from various automated systems and prepares specialized
reports.
  • Perform telephonic clinical reviews to Behavioral Health Managed Care Organizations in order to obtain ongoing authorization.
  • Ensure completion of Medicare Physician Certification according to regulatory timeline.
  • Collects demographic and insurance data and enters accurately into specialized automated
systems.
  • Prepares, reviews for completion, and maintains required documents in accordance with
established procedures, time frames and regulatory requirements.
  • Makes contact to obtain missing information for incomplete forms.
  • Advises patients and clinical staff of problems with insurance authorizations and resubmits
requests with additional or revised information.
  • Contacts insurance providers to confirm level of benefits for inpatient admissions.
  • Responds to customer inquiries and provides information.
  • Serves as liaison between the physician's offices, patients, case management department and
Patient Registration.
  • Follows up with patients, physicians, clinical and ancillary departments to ensure optimum
delivery of services.
  • Communicates with case managers, hospital personnel, and external agencies to provide

information or resolve discrepancies.

Qualifications/Requirements:

Experience: Two to three years of clerical experience in health care field or related area required, with preference to behavioral health experience.

Education:

A high school diploma or equivalency required, Associates Degree Preferred

Licenses / Certifications: N/A

  • Laboratory Support Specialist

    6 days ago

    Valhalla, New York, United States WMC Health Full time

    Job DescriptionAs a Laboratory Support Specialist at WMC Health, you will play a vital role in supporting laboratory tests and procedures. Your primary responsibilities include preparing, dispensing, and sterilizing media and glassware, as well as assisting with complex laboratory tests.Key Responsibilities:Receiving and sorting specimens for diagnostic...

  • Litigation Support Specialist

    2 days ago

    Valhalla, United States Kaufman Borgeest & Ryan Full time

    Job OverviewKaufman Borgeest & Ryan seeks a detail-oriented Paralegal to process medical record authorizations and provide general litigation support in Valhalla, NY.This is an excellent opportunity for a skilled professional with strong organizational and writing skills to join our team.The successful candidate will have a working knowledge of Microsoft...

  • Communications Specialist

    5 days ago

    Valhalla, New York, United States Fedcap Rehabilitation Services Full time

    Job Summary: We are seeking a highly skilled Speech Language Pathologist to join our team at Fedcap Rehabilitation Services. The ideal candidate will possess a Master's degree in Speech Pathology and be certified by the American Speech-Language-Hearing Association.\rAbout the Role: As a Speech Language Pathologist, you will evaluate communication skills in...