Authorizations Specialist

Description:

Position Overview:

The Authorization Specialist supports the Clinical, Imaging, and Physical Therapy departments. Daily tasks will include verification of a patient’s insurance information, obtaining authorizations for, but not limited to, procedures, surgeries, injections, imaging, office visits, and pre-collection for upcoming services to be rendered. This role will also actively interact with the medical staff and patients.

ESSENTIAL FUNCTIONS:

• Authorize scheduled procedures to include surgeries, injections, medications, imaging and other items needing authorization with insurance.
• Verify eligibility and benefits for all patients and procedure codes, pre-collect payment for surgeries and other procedures as required by the department
• Ensure compliance with benefits, authorizations, and/or funding requirements and limitations.
• Confirm that all information documented in the Practice Management System is accurate.
• Document work processes as required.
• Educate staff members on authorization obligations and accountability to internal processes in a timely manner.
• Manage authorization queue by auditing daily changes and having clear documentation.
• Setup Patient tracking via tasking within the patient Electronic Medical Records System.
• Innovation of processes to facilitate the most efficient workflow.
• Document in Electronic Health Records System prior authorizations information obtained.
• Treatment authorized, date range approved for, authorization numbers and insurance company contact information.
• Must be able to recognize and respond appropriately to urgent situations.
• Follow all written protocols and procedures of the clinic including the OCC handbook, all department policy and procedures.
• Provide timely, high quality patient service and submission of authorizations, from all areas of responsibility by being courteous and helpful to all.
• Perform other duties assigned by OCC leadership.

Requirements:

REQUIRED QUALIFICATIONS AND SKILLS:

• Medical terminology, ICD-10 and CPT coding knowledge
• Knowledge of contracted insurance plans and procedures
• Solid computer and phone skills
• Strong organizational and interpersonal skills
• Ability to prioritize responsibilities and multi-task efficiently and effectively
• Adaptability to different plan and lien requirements

PAY & BENEFITS:

• Medical, Dental and Vision Insurance
• Generous PTO package and paid holidays
• Company-paid life insurance and long term disability insurance
• Ability to purchase accident insurance, short and long-term disability insurance.
• Opportunities for internal training and development
• Retirement Plan eligibility after one month of service with eligibility in company profit sharing
• Most positions offer Monday – Friday work schedules

WORKING CONDITIONS:

• Typical business office environment
• Possibility of local travel
• Constant viewing of computer monitor, mousing and typing
• Frequent standing, walking, sitting, lifting, bending, handling up to 10 pounds
• Specific vision abilities required by this job include close vision, color vision, peripheral vision, and ability to adjust focus
• Hours of business are Monday – Friday from 8:00 a.m. to 5:00 p.m. Must be able to work early, late and long hours, as needed, to meet the essential functions of the job