Pre-Authorization Specialist
6 days ago
The Pre-Authorization Specialist plays a crucial role in the Pre-Authorization Department, responsible for verifying patient eligibility, obtaining insurance benefits, and ensuring pre-certification authorization and referral requirements are met prior to delivering inpatient, outpatient, and ancillary services. This individual determines which patient services have third-party payer requirements and is responsible for obtaining the necessary authorizations for care.
Key Responsibilities:- Verify insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
- Successfully work with payers via electronic, telephonic, and/or fax communications.
- Responsible for verification and investigation of pre-certification authorization and referral requirements for services.
- Coordinate and supply information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits.
- Collaborate with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
- Communicate with patients, clinical partners, financial counselors, and others as necessary to facilitate authorization process.
- Facilitate submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals.
- Appropriately prioritize workload to ensure the most urgent cases are handled in a timely manner.
- Complete accurate documentation in both the Auth/Cert and Referral Shells.
- Minimum of two years experience in hospital billing/pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Medicaid, HMOs, and PPOs required.
- Prior experience in a business office position with strong customer service background preferred.
- Exceptional customer relations skills required.
- Knowledge of online insurance eligibility systems.
- Excellent typing and computer skills.
- Familiarity with Medical Terminology.
- Demonstrated ability to efficiently organize work and maintain a high level of accuracy and productivity.
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Pre-Authorization Specialist
6 days ago
, WI, United States LanceSoft Full timeJob Title: Pre-Authorization SpecialistLanceSoft is seeking a highly skilled Pre-Authorization Specialist to join our team. As a key member of our Pre-Authorization Department, you will be responsible for verifying patient eligibility, obtaining insurance benefits, and ensuring pre-certification authorization and referral requirements are met prior to the...
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Pre-Authorization Specialist
2 weeks ago
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Prior Authorization Specialist
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Authorization Specialist
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Authorization Specialist
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Authorization Specialist
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Authorization Specialist
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Authorization Specialist
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Authorization Specialist
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Prior Authorization Specialist
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Insurance Authorization Specialist
2 weeks ago
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Medical Authorization Representative
4 days ago
Garden City, NY, United States Orlin & Cohen Medical Specialist Group Full timeOrlin & Cohen is one of the largest orthopedics practices in the region, with 20 offices in Nassau and Suffolk Counties, Queens, and Staten Island. We have been in business for more than 25 years and have over 1200 dedicated healthcare employees in our care. Team members enjoy competitive salaries, exceptional medical benefits, and generous PTO.We are...
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Authorization Specialist III
3 weeks ago
Colorado Springs, CO, United States VirtualVocations Full timeA company is looking for an Authorization Specialist III to support the prior authorization request process in the utilization management team. Key Responsibilities Track and maintain authorization requests in accordance with insurance guidelines Verify member insurance coverage and perform data entry for complex authorization requests Act as a...
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Prior Authorization Specialist
3 weeks ago
San Diego, CA, United States VirtualVocations Full timeA company is looking for a Prior Authorization Specialist to manage authorization requests for outpatient diagnostic and surgical services. Key Responsibilities Determine authorization requirements and escalate cases as needed Submit authorization requests and gather clinical data for insurance companies Follow up with physician offices and patients...
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Reimbursement Authorization Specialist
6 days ago
, MA, United States Lionstep AG Full timeJob SummaryWe are seeking a highly skilled Reimbursement Authorization Specialist to join our team at Ajinomoto Cambrooke. As a key member of our Revenue Cycle Department, you will play a critical role in ensuring the accuracy of all necessary documentation and coordination with healthcare professionals, agencies, and payers to facilitate patient access to...
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Authorization Specialist
2 weeks ago
, IL, United States Addus HomeCare Full timeAuthorization Clerk Job DescriptionWe are seeking a highly organized and detail-oriented Authorization Clerk to join our team at Addus HomeCare. As an Authorization Clerk, you will play a critical role in ensuring that our patients receive the necessary authorizations for private insurance coverage.Key Responsibilities:Track and request all authorizations...