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Insurance Authorization Specialist
2 months ago
Position Summary
The Insurance Authorization Specialist is responsible for managing all aspects of insurance authorizations for medical procedures and diagnostic evaluations.
Key Responsibilities
- Conduct thorough verification of insurance benefits for all new patients and assess out-of-network deductibles.
- Communicate financial responsibilities to patients regarding their office visit obligations.
- Document all authorizations and benefit details within our Electronic Medical Records (EMR) and Practice Management systems.
- Review Independent Medical Exam (IME) reports and notify healthcare providers if a patient has achieved maximum medical improvement.
- Implement alerts in the practice management system for staff regarding patient status changes.
- Notify staff of any denied benefits or authorizations.
- Address inquiries from patients concerning their insurance authorizations via written and verbal communication.
- Secure authorizations for all diagnostic tests requested by physicians.
- Coordinate scheduling of procedures across various locations, including hospitals and outpatient surgery centers.
- Prepare surgical documentation and ensure all necessary medical clearances and lab results are obtained.
- Provide operative reports to surgical facilities as required.
- Maintain and update the physician's procedure list.
- Keep staff informed of any changes in workers' compensation regulations.
- Follow up on any cancelled procedures to ensure proper rescheduling.
- Facilitate effective communication with office staff, administration, hospital representatives, insurance company contacts, referring physician offices, and other healthcare professionals.
- Exhibit professionalism in all interactions with patients, colleagues, and external medical representatives.
- Organize and maintain a systematic filing system for efficient workflow.
- Possess a comprehensive understanding of practice management software and EMR systems relevant to job functions.
Qualifications
- High school diploma or equivalent (GED) is required.
- A minimum of three (3) years of experience in medical insurance coordination and authorizations within a multi-provider specialty practice is essential.
- Ability to maintain confidentiality of sensitive information at all times.
- Exceptional verbal and written communication skills are necessary.
- Demonstrated customer service skills while ensuring high-quality patient care.
- Strong organizational and multitasking abilities with meticulous attention to detail.
- Aptitude for following instructions in various formats, including written and oral.
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) is required.
- Capability to learn and adapt to new software technologies for electronic patient records and scheduling systems.
