Authorization Specialist
6 days ago
We are a physician-led, patient-centric network dedicated to simplifying healthcare and delivering connected care services. Our multispecialty and urgent care providers serve millions of patients across traditional practices, patients' homes, and virtually through our operating companies.
Our team is committed to making healthcare better for all by innovating value-based care and leveraging integrated applications, population insights, and staffing expertise.
Job DescriptionPosition Summary:The Authorization Specialist is responsible for obtaining authorizations for surgical procedures, diagnostic testing, medications, DME, outgoing referrals, and other services as part of the daily operations of the Revenue Cycle Department.
This role requires a deep understanding of medical insurance and clinical policies to determine authorization protocols for each health plan.
Essential Job Functions:- Identify appointments and procedures requiring authorization by monitoring schedules, system reports, and dashboards.
- Verify insurance eligibility and benefits, and update patient information as necessary.
- Complete referrals and prior authorizations in a timely manner according to department guidelines and workflows.
- Communicate effectively with patients, physicians, office staff, and manager to resolve issues affecting authorization requests.
- Demonstrate system knowledge, ability to run reports, document and manage referrals and authorizations, and other system tasks within user security access.
- Request, prepare, and recognize documentation required to support medical necessity for authorized services.
- Provide supervisor and manager with feedback on issues affecting workflow, reimbursement, and customer service.
- Ensure accurate information is entered in patient accounts.
- Collaborate with Reimbursement Department teams to limit denials and ensure proper reimbursement.
- Meet department deadlines and benchmarks.
- Maintain patient confidentiality.
- Expert in selecting correct insurance package in Epic.
- Update authorizations and claims to reflect new insurance package.
- Expert in sorting work queues and reports to identify and process daily work.
- Move correspondence from dashboard to patient account.
- Expert in generally accepted insurance benefit terms and processes.
- Expert in communication with physicians, practice staff, peers, supervisor/manager, and payers.
- Expert in requesting and preparation of supporting documentation.
- Investigate authorization denials and appeals.
- Patient Financial Counseling.
Work with patients to estimate out-of-pocket costs and explore co-pay assistance, free drugs, or grants they may qualify for. Meet with patients to discuss options and work with ordering providers to find alternative medications if necessary.
Education, Certification, Computer, and Training Requirements:- High School Graduate/GED Required.
- Vocational/Technical School/Diploma Program Preferred.
- 2-4 years of related experience Preferred.
- Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) Preferred.
- Experience with Standard Office Technology in a Windows-based environment & Microsoft Office Suite Required.
VillageMD values the critical role health and wellness play in the lives of our team members and their families. Our benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages, and a 401k savings plan.
Equal Opportunity EmployerVillageMD provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.
Safety DisclaimerVillageMD cares about the safety of our employees and applicants. We do not use chat rooms for job searches or communications. We will never request personal information via informal chat platforms or unsecure email. We will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview.
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