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Authorization Specialist

3 months ago

Melville, United States Medix Full time

We are hiring for an Authorization Specialist to join our team in the Melville, NY area. We are seeking candidates who are professional, reliable, and match the listed qualifications below.

What's in it for you?

  • Dental, health, vision
  • Weekly Pay
  • PTO
Hours: Monday - Friday day shift (can select schedule: 8:00a-4:00p, 8:30a-4:30p)

Job Type: Contract with potential to be brought on permanently

Job Title: Authorization Specialist

Pay: $20-27/hr

Available Location(s): Melville, NY

Overview

The Authorization/Financial Clearance Specialist is responsible for ensuring a patient's visit is financially secured, which requires communication with patients, physicians, office staff, clinicians, and insurance companies to obtain and accurately record patient demographic and insurance information.

The role performs insurance verification, insurance notification and authorization, patient financial responsibility communication, and other patient access operational activities.

The Authorization/Financial Clearance Specialist will update patient insurance coverage, send notification to payers for non-scheduled admissions, and ensure pre-certification/authorization requirements are complete prior to the date of service. The role will work closely with Utilization Management, Patient Accounts, and other key stakeholders in the revenue cycle to ensure all pertinent patient and insurance information is on file for clinical submission and billing.
  • Utilize workdrivers and reports, as assigned by management, to ensure completion of financial clearance functions for all in-scope patients.
  • Confirm and document the patient's health insurance(s) effective dates, network status, service coverage requirements, and patient liabilities including deductible, coinsurance and co-payment amounts. This may be completed multiple times before, during, and after a patient's visit/stay.
  • For scheduled services, review and analyze patient visit information to determine whether authorization is needed and utilize payer specific procedures to appropriately secure authorization in order to clear the account prior to service where possible.
  • For non-scheduled services such as inpatient admissions, observation care, maternal care, and emergency surgeries and procedures, notify the patient's insurance within 24 hours of admission or date of service, coordinate with Case Management and Utilization Management for insurance required documentation
  • Use financial estimate process to make patients aware of estimated financial responsibility, collect and document receipt of estimated patient responsibility amounts prior to service, and appropriately refer them to financial counseling when necessary.
  • Utilize problem solving skills to determine the best course of action to resolve any problems created as a result of insurance coverage or prior authorizations.
  • Foresee and communicate to management team any significant issues/risks.
  • Propose innovative ideas and solutions to enhance operational efficiencies.
  • Maintain knowledge of The Joint Commission and state/federal regulations, laws and guidelines that impact Financial Clearance functions and Patient Access Services.
  • Comply with Medical Necessity protocols and proper use of Compliance Checker and National Coverage Decisions.
  • Maintain knowledge of Medicare, Medicaid and third-party payer regulations and hospital charging and collection policies.
  • Responsible for other duties as assigned.
Requirements:
  • High school diploma
  • Must have an authorization background/experience
  • Must have a comprehensive understanding of insurance pre-certification requirements, contract benefits, and medical terminology.
  • Work requires the ability to access online insurance eligibility and pre- certification systems.
  • Must have expertise in insurance, managed care and federal/ state coverage.
  • Must be customer focused with strong interpersonal skills and courteous with patients, family members, physicians, and staff members.
  • Must be able to discuss and complete financial arrangements on the estimated patient liability under stressful conditions while maintaining positive patient relations.
  • Work requires a high level of problem solving skills
  • Work requires the ability to interpret and execute policies and procedures.

Apply today