Authorization Specialist

2 months ago

Millersburg, Ohio, United States Pomerene Hospital Full time
Job Overview

Position Summary

The Authorization Specialist plays a crucial role in securing necessary approvals for all medical procedures by effectively navigating the authorization process with various insurance providers.

Key Responsibilities


• Assess medical records to confirm that patients align with the established medical policy criteria.


• Dispatch referral requests to external healthcare providers and ensure follow-up with patients regarding their appointment status.


• Manage incoming authorization requests through payer portals or via telephone, consistently following up on outstanding cases.


• Maintain comprehensive payer documentation, ensuring that all requirements for successful authorization are current.


• Initiate appeals for any denied authorization requests.


• Address inquiries from clinic staff regarding payer medical policy standards.


• Verify the accuracy of CPT and ICD-10 codes in procedural orders.


• Communicate with patients to update them on the status of their authorizations.

Qualifications

High School Diploma or GED is required.

Experience and Skills


• Familiarity with the authorization process and its influence on the financial operations of the practice.


• Proficient in computer applications, including Excel, Word, and internet navigation.


• Knowledge of payer medical policy guidelines and the ability to apply these in managing authorizations efficiently.


• Strong customer service abilities, with clear and effective communication skills.


• Capacity to handle multiple tasks while maintaining focus in a fast-paced, time-sensitive environment.


• Prior experience in medical prior authorization is preferred but not mandatory.

Employee Benefits

  • Medical Insurance
  • Dental Coverage
  • Vision Insurance
  • Life Insurance
  • Voluntary Accident Coverage
  • Voluntary Critical Illness Insurance
  • Short-Term Disability
  • On-the-Job Training Opportunities
  • Flexible Spending Account (FSA)
  • 403(b) Retirement Plan
  • Employer Matching for 403(b)
  • Employee Discounts at Kinetic Fitness
  • Employer Sponsored Certifications
  • Paid Orientation
  • Tuition Reimbursement
  • Paid Time Off

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