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Medical Authorization Specialist
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Medical Authorization Specialist
2 months ago
Premier Medical Resources is a leading healthcare management company seeking a highly skilled Medical Authorization Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for ensuring accurate and timely pre-certifications, pre-authorizations, and referrals for all services.
Key Responsibilities- Prioritize and manage incoming authorization requests to ensure timely and accurate processing.
- Generate, verify, and oversee the complete procedure authorization/referral process to ensure compliance with regulatory requirements.
- Manage and resolve day-to-day issues related to pre-authorization, including communicating with providers and payers.
- Monitor provider network status and notify relevant parties of non-network providers.
- Obtain authorization through various channels, including fax, payer websites, and phone, and follow up on pending cases.
- Notify relevant departments of approvals and denials, and initiate appeals as necessary.
- Coordinate P2P requests with the appropriate department.
- Confirm accuracy of CPT and ICD-10 diagnoses in procedure orders.
- Contact patients to discuss authorization status and provide updates.
- Maintain and update payer medical policy guidelines to ensure compliance with authorization requirements.
- Request and review patient documentation as needed, and submit necessary information to payers.
- Assist with patient scheduling and inquiries as necessary.
- Effectively utilize ICD-10, CPT, modifiers, and other codes according to coding guidelines.
- Communicate effectively with providers, payers, and other departments regarding missing information and authorization processing.
- High school diploma or equivalent
- Two years of medical office or facility setting experience
- Knowledge of in- and out-of-network insurances, insurance verification, patient responsibility, and prior authorization processes
- Familiarity with ICD-10 and CPT codes and procedures
- Ability to review and understand patient medical documentation
- Ability to independently identify and understand medical necessity requirements
- Task-oriented and organizational skills
- Detail-oriented focus
- Ability to work independently and as a team
- Ability to adapt with flexibility
- Effective communication skills
