Authorization Specialist
2 days ago
The Authorization Specialist at Upstate University Hospital plays a crucial role in ensuring that all information is accurately coded to obtain authorizations for maximum reimbursements. This involves working closely with providers, patients, ancillary departments, pharmacy, and insurance carriers to ensure seamless communication and efficient processing of authorizations.
Key Responsibilities:
• Collaborate with healthcare teams to gather and verify patient information, medical records, and insurance details.
• Utilize knowledge of medical terminology, ICD, CPT, and J codes to effectively communicate with insurance carriers and ensure accurate coding.
• Develop and maintain strong relationships with patients, families, and healthcare professionals to ensure excellent customer service and support.
• Analyze and resolve authorization issues, working closely with insurance carriers and other stakeholders to ensure timely and accurate resolution.
Requirements:
• Associate's degree and three years of relevant patient financial/insurance services experience, or equivalent combination of education and experience.
• Strong knowledge of medical billing requirements, insurance fraud/abuse, and medication reimbursement.
• Excellent problem-solving skills, computer, and keyboarding skills, with the ability to maintain accurate records and data.
• Strong communication and interpersonal skills, with the ability to work effectively in a team environment.
Preferred Qualifications:
• Prior experience working with ambulatory patient care administrative functions, collecting/analyzing data, and organizing record-keeping systems.
• Knowledge of medical billing requirements and ability to recognize insurance fraud/abuse strongly preferred.
• Experience with healthcare insurance prior authorization/coding and performing insurance carrier/managed care review preferred.
Work Environment:
This role requires a flexible schedule, with the ability to work Monday-Friday with flexible hours. The successful candidate will be based at Upstate University Hospital, with opportunities for professional growth and development in a dynamic and supportive environment.
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