Authorization Specialist
2 months ago
Position Summary
Obtains prior authorization on allscheduled diagnostic testing and procedures ordered by group physicians, bothin office and off-site, as required by insurance to secure payment. Documents appointmentschedule and EMR in effective and detailed manner.
Job Responsibilities
• Maintainsa current knowledge of insurance requirements for prior authorization
• Understandswhich primary and secondary participating insurances require authorization
• Demonstratesknowledge of CPT and ICD-10 codes relevant to the practice
• Monitorsall clinic testing schedules to ensure prior authorization is obtained asrequired by carrier; reviews schedules frequently for changes
• Utilizesonline or telephone tools to obtain authorization numerous days in advance ofappointment
• Submitstimely authorization requests and ensures required documentation is submitted
• Maintainsaccurate EMR documentation with reference or authorization numbers, dates,initials
• Obtainsand documents deductible and copay information required for testing.
• Retroreviews hospital procedures (via pMD or otherwise) to ensure authorizationsobtained in timely manner.
• Maintainsopen and timely communication with all clinical staff on all priorauthorization issues
• Maintainsa friendly and professional manner with coworkers, patients, insurancecarriers, etc.
• Communicateswith patient regarding insurance problems and authorization delays,rescheduling patient if necessary
• Utilizespatient scheduling and chart software in proficient manner.
• Followconfidentiality and security rules when providing patient information; followsHIPAA guidelines.
• Adhereto OSHA guidelines and participate in safety program
• Performany other services deemed reasonable by physician or team lead.
Qualifications
Educationand Experience: High school diploma or equivalent. Aminimum of one year's experience with insurance and medical billing,specifically with authorizations.
Knowledge:Modern operational methods inherent to amedical practice; clerical equipment, operations and processes; must have basicunderstanding of medical terms and abbreviations; usage of computer systems;patient confidentiality/HIPAA regulations.
Abilities:Ableto multi-task in fast-paced environment, be detail-oriented; is well-organized;demonstratemoderate computer skills, utilize proper telephone etiquette; maintain professionalismin difficult situations; establish and maintain cooperative relationships withstaff members; create a responsive, caring environment for patients; respondpromptly to physicians' directions; maintain medical records in a concise andaccurate manner; react quickly in emergency situations; recognize and preventpossible safety hazards; exercise independent judgment; communicate clearly andconcisely. Fosters a positive working environment that is responsive to patientneeds.
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