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Authorization Specialist
2 months ago
We are seeking a highly skilled Authorization Coordinator to join our team at Radiation Billing Solutions, Inc. The successful candidate will be responsible for effectively acquiring radiation oncology authorizations, working denied authorizations, and submitting appeals as needed.
Key Responsibilities- Submit referral, precertification, and/or authorization requests for radiation oncology services in a timely manner to ensure 100% of patients requiring authorization are positively impacted.
- Average time from precertification and/or authorization request notification and submission to approval should not exceed 5 business days.
- Review client queues and schedules daily to identify patients requiring authorization per payer requirements.
- Review guidelines to confirm if no authorization is required, ensuring exams meet medical necessity.
- Communicate with physician/clinical staff on authorization issues and/or pre-certification requirements by the patient's insurance carriers.
- Identify and address denied authorizations, including the appeal process and denial resolution.
- Notify Billing Departments of any special instructions, such as Skilled Nursing Facility or Inpatients, with a demonstrated error rate of less than 3% on voids and/or rebills.
- Document accurate authorization activity to reflect work performed in physician/hospital systems, billing systems, and other systems as needed for reporting and tracking.
- Create relationships at the payer level to assist with initial authorization approval, reduce the need for peer-to-peer, and guarantee the successful reversal of authorization denials.
- Participate in all required meetings with clients/personnel, becoming an integral part of the team.
- Review processes and provide suggestions for process improvements and efficiencies.
- Stay up-to-date on all CPT/HCPCS/ICD-10 code changes and all payer policy authorization requirements.
- High School Diploma or equivalent.
- Minimum 1 year experience with prior authorization services.
- Oncology experience is a plus.
- Working knowledge of oncology-specific codes and payer rules for commercial, Medicare, Medicare Advantage, and Medicaid plans preferred.
- Knowledge of ICD10, CPT, and HCPCS codes and rules for Tech/Pro/Global and Freestanding/HOPPS coding preferred.
- Ability to lift/carry up to 25 pounds.
- Ability to sit/stand for long periods of time.
- Good manual dexterity with the ability to perform repetitive hand/wrist motions.
- Requires mastery of complex language, comprehension, reasoning, and analytical skills typically found in mid to high-level work.
- Typical office environment.
- Works onsite at client location. May require travel at times to RBS office locations.
- Moderate noise levels.
