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Rehabilitation Authorization Specialist
2 months ago
At Hirebridge Organic, we pride ourselves on providing outstanding musculoskeletal care. Our dedicated team has been serving the orthopedic needs of our community with state-of-the-art facilities and a commitment to compassionate patient care.
The Rehabilitation Authorization Specialist plays a crucial role in ensuring that our patients receive the necessary insurance benefits and precertification for therapy services. This position requires a high level of customer service to patients, colleagues, and external partners.
Key Responsibilities:
- Secure authorizations through payer websites or phone communications, ensuring timely follow-ups on pending cases.
- Collaborate with the Workers Compensation Department, Case Managers, and Adjustors to facilitate authorization for Work Comp patients.
- Assess and prioritize incoming authorization requests based on urgency.
- Maintain comprehensive payer files, ensuring all requirements for successful authorization are up to date.
- Initiate appeals for any denied authorizations.
- Provide guidance to clinic staff regarding payer medical policy guidelines.
- Verify the accuracy of CPT and ICD-10 codes in procedure orders.
- Communicate with patients to update them on their authorization status.
- Document all activities in the practice management system.
- Perform additional duties as assigned.
Core Competencies:
- Responsible Decision Making
- Integrity and Accountability
- Adaptability and Flexibility
- Team Collaboration
- Compliance with HIPAA regulations
- Professionalism and Strong Work Ethic
- Proficient understanding of CPT and ICD-10 coding
- Knowledge of authorization procedures
- Familiarity with payer medical policy guidelines
Qualifications:
- Minimum age of 18 years.
- Reliable transportation is essential.
- Proficiency in Microsoft Word, Excel, and Outlook.
- Digital literacy is required.
Experience:
A minimum of 2 years of experience in healthcare insurance is required, with a preference for therapy-related experience.
Education:
A high school diploma or equivalent is required; an associate or bachelor's degree is preferred.
Essential Skills:
- Ability to analyze situations and provide solutions.
- Strong ethical reasoning and decision-making capabilities.
- Attention to detail is critical.
- Receptive to feedback and responsive to constructive criticism.
- Excellent verbal and written communication skills.
- Effective time management and prioritization skills.
Physical Requirements:
This role may require prolonged periods of sitting or standing, working longer than eight-hour shifts, and the ability to perform tasks that involve hand dexterity, reaching, climbing, balancing, stooping, kneeling, crouching, talking, and hearing. Specific vision abilities required include close vision and the ability to focus. Reasonable accommodations can be made for individuals with disabilities to perform essential job functions.
Compliance:
All employees are expected to adhere to organizational policies and procedures, uphold the Code of Conduct, complete required compliance training, and report any instances of non-compliance.
Equal Employment Opportunity Statement:
We are committed to providing equal employment opportunities regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or veteran status.
