authorization coordinator

Elevate Patient Financial Solutions

<div><div><b>Elevate Patient Financial Solutions </b>has an exciting career opportunity available as a <b>Bilingual Scheduling and Authorization Coordinator.</b> This position will be a remote role <b>required to live in the Pacific or Mountain time zones</b>. The Full-Time schedule for this role will be <b>Monday through Friday 8 AM to 5 PM (PST or MST required).</b></div>
<div></div><div><b>Job Summary</b></div>
<div></div><div>The Scheduling and Authorization Coordinator delivers exceptional customer service when communicating with patients over the phone to provide the necessary information for applicable scheduling and imaging. They request information related to the coordination and scheduling of diagnostic imaging and other procedures and treatments for hospitals contracted with ElevatePFS&reg;. The Scheduling and Authorization Coordinator interacts directly with the patients, referring physicians, Hospital Services</div>
<div>, and internal company associates to guarantee smooth coordination of procedures and exams.</div>
<div></div><div><b>Essential Duties and Responsibilities</b></div>
<div></div><div><b>Insurance Authorization/Verification</b></div>
<div></div><ul><li>Thoroughly completes the insurance verification process to ensure the accuracy of insurance information.</li>
<li>Obtains insurance authorizations, referral, and treatment consults as needed for all scheduled patients prior to receiving services.</li>
<li>Obtains benefit coverage from insurance companies and accurately enters information into the appropriate computer system.</li>
<li>Obtains diagnosis information and/or CPT code from the physician/office or the outpatient department, as necessary for completing the insurance authorization process.</li>
<li>Maintains proficiency in the various systems utilized during insurance verification and authorization process including various on-line payor eligibility programs.</li>
<li>Monitors appropriate work lists to ensure timely insurance verification processing.</li>
<li>Maintains documentation necessary for compliance with state, federal, and other regulatory agency requirements.</li>
<li>Maintains proficiency in the various systems utilized during insurance verification and authorization process including various on-line payor eligibility programs.</li>
</ul>
<div></div><div><b>Scheduling</b></div>
<div></div><ul><li>Schedules all types of complex exams with attention to detail.</li>
<li>Ability to manage high outbound and inbound calls to schedule patients for imaging services to ensure the best possible customer service by properly educating the patient on exam preparation and answering questions.</li>
<li>Screens and verifies all HIPPA information to ensure accuracy with scheduling and speaking with patients, patients approved representatives and or physicians.</li>
<li>Schedules and documents notes in hospital and ElevatePFS&reg; operating systems.<br>
</li></ul><div><b>Clerical</b></div>
<div></div><ul><li>Monitors and manages the e-mail inbox or fax machine for assigned practices throughout the day.</li>
<li>Works any requests received via e-mailed or fax.</li>
<li>Checks and responds to voicemails.</li>
<li>Creates, maintains and monitors log of patients and procedures scheduled for assigned physician practices.</li>
<li>Monitors appropriate work lists to ensure timely insurance verification processing.</li>
<li>Utilizes multiple commuter application, scheduling software, network, drives to schedule multiple exams within multiple modalities and entities across the hospitals system.</li>
</ul>
<div></div><div><b>Additional Responsibilities</b></div>
<div></div><ul><li>Effectively communicates operational activities and issues with Supervisor and Manager.</li>
<li>Interfaces courteously and effectively with internal and external customers. Must consistently present a positive departmental and organizational image, as well as commitment to departmental goals, objectives, standards, policies and procedures.</li>
<li>Demonstrates proficiency within assigned area of responsibility and a general understanding of the entire Patient Access process.</li>
<li>Adheres to the hospitals and until level policies and procedures and safeguards set forth by each facility.</li>
<li>Identifies and recommends process improvements for RMA services.</li>
<li>Other duties as assigned.</li>
</ul>
<div></div><div><b>Qualifications and Requirements</b></div>
<div></div><ul><li>High school diploma or GED</li>
<li>Associate degree or 2+ years in patient scheduling, registration, or healthcare billing is preferred</li>
<li>Over one (1) year working in a customer service or client relations type role</li>
<li>Effectively communicate both orally and written, to a variety of individuals utilizing fluent Spanish and English.</li>
<li>Office or hospital environment experience is preferred</li>
<li>High volume call center experience is preferred</li>
<li>Strong Literacy (grammar, spelling, math)</li>
<li>Strong Microsoft Products experience, including word, excel, outlook, windows</li>
<li>Familiarity with HCA/Parallon IT systems is preferred</li>
<li>Strong sales and customer service skills</li>
<li>Excellent interviewing and telephone communication skills</li>
<li>Outstanding interpersonal and people‑oriented skills</li>
<li>Excellent written and verbal communication abilities</li>
<li>Ability to communicate assertively and professionally while maintaining confidence and credibility.</li>
<li>Strong analytical, problem‑solving, and decision‑making skills</li>
<li>High level of organization, attention to detail, and time management</li>
<li>Ability to multitask and prioritize effectively in a fast‑paced environment</li>
<li>Proven ability to work independently with minimal supervision</li>
<li>Strong stress management and adaptability skills</li>
<li>Goal‑driven with a strong action and results orientation</li>
<li>Demonstrates initiative, persistence, and a strong work ethic</li>
<li>Team‑oriented with the ability to collaborate effectively</li>
<li>Flexible and adaptable to changing priorities</li>
<li>High standards of honesty, integrity, and professionalism</li>
<li>Profit‑ and performance‑oriented mindset</li>
<li>Remote and hybrid positions require internet connectivity that meet the Company&rsquo;s upload and download requirements.</li></ul><br>
<div>
</div><div></div><div><br>
<b>Benefits</b></div>
<div></div><div>ElevatePFS believes in making a positive impact not only within our industry but also with our employees &ndash;the organization&rsquo;s greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.</div>
<ul><li>Medical, Dental &amp; Vision Insurance</li>
<li>401K (100% match for the first 3% &amp; 50% match for the next 2%)</li>
<li>15 days of PTO</li>
<li>7 paid Holidays</li>
<li>2 Floating holidays</li>
<li>1 Elevate Day (floating holiday)</li>
<li>Pet Insurance</li>
<li>Employee referral bonus program</li>
<li>Teamwork: We believe in teamwork and having fun together</li>
<li>Career Growth: Gain great experience to promote to higher roles</li></ul><br>
<div></div><div>The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.</div><br>
<div></div>
<div></div><div><i>The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.</i></div>
<div></div><div><b>Elevate, PFS is an Equal Opportunity Employer</b></div></div>

Bilingual Scheduling and Authorization Coordinator (PST or MST location required)

MEDPOINT MANAGEMENT

<div><h3 class="jobSectionHeader"><b>Summary</b></h3><div>
Thursday-Monday 8am-5pm. The Outpatient UM Coordinator provides effective communication between MSO, IPA providers, and members to coordinate member care. Communication to include accessibility to care, validating contract entities, and ensuring timeliness standards are met. The Outpatient UM Coordinator reports directly to the Outpatient Lead Coordinator under the guidance of the Supervisor.</div><p></p><h3 class="jobSectionHeader"><b>
Duties and Responsibilities:</b></h3><ul><li>
Process authorization requests per state and federal timeliness regulations</li><li>
Validate data entry process for errors</li><li>
Verify member benefits and eligibility upon receipt of treatment authorization request</li><li>
Utilizes authorization matrix, ancillary rosters, DOFR and/or delegation agreements to drive decision-making</li><li>
Coordinates with referral Clinician and/or Medical Director for timely processing</li><li>
Communicate with Medical Directors to facilitate Medical Reviews for non-clinical medical review referrals</li><li>
Outreach to members on adjudication decisions</li><li>
Outreach to providers offices when additional information is needed</li><li>
Maintain knowledge of CMS &amp; Medi-Cal policy guidelines i.e. Medicare LCD vs NCD</li><li>
Identify &amp; inform Case Management Clinician on complex care diagnoses</li><li>
Screen cases for possible California Children Services (CCS) eligible condition</li><li>
Read and maintain email inquiries</li><li>
Collaborate with other departments (i.e. Claims, PNO, etc.) to resolve member/provider matters as needed</li><li>
Data entry for additional requested services, as needed</li><li>
Assist with special projects, as needed</li><li>
Assists other team members with their workload, as needed</li><li>
Regular attendance at UM team meetings</li></ul><p></p><h3 class="jobSectionHeader"><b>
Minimum Job Requirements:</b></h3><ul><li>
High School graduate or GED equivalent</li><li>
One-year medical office experience</li><li>
Knowledge of medical terminology</li><li>
Proficiency in Microsoft Office programs, especially Word and Excel</li><li>
Proficiency in EZCAP a plus</li></ul><p></p><h3 class="jobSectionHeader"><b>
Skills and Abilities:</b></h3><ul><li>
Ability to multi-task while remaining adaptable and flexible to fast-paced environment</li><li>
Reliable, dependable, and accountable</li><li>
Strong customer service skills with good telephone rapport</li><li>
Ability to empathize with complex cases</li><li>
Self-Motivation and ability to work effectively in an independent environment</li><li>
Great critical thinking and problem-solving skills</li></ul><p></p><h3 class="jobSectionHeader"><b>
Salary Range:</b></h3><ul><li>
$21 &ndash; $23 hourly</li></ul></div>

Outpatient UM Coordinator (Thursday-Monday 8am-5pm)

Blanchard Valley Health System

<div><p><b>PURPOSE OF THIS POSITION</b></p><p>
The primary purpose of this position is to plan and coordinate the authorization functions for BVHS patients. Act as a liaison between the physicians, facilities, patients and professional billing companies. Coordinates information between patients, their insurance companies, and the facilities at which the patient is being served. Responsible for accurately entering patient data and interpreting insurance verification and coverage for patients.</p><p><b>
JOB DUTIES/RESPONSIBILITIES</b></p><ul>
<li>
Duty 1: Ability to process patient authorizations in a timely manner with accurate data.</li>
<li>Duty 2: Ability to use current EHR system and all insurance verification and authorization tools, identifies and confirms active insurance coverage and required authorizations for outpatient and inpatient services. Ability to discover/provide clinical data in the EHR or from the ordering provider to support authorization needs.</li>
<li>Duty 3: Ability to effectively communicate with insurance and governmental agencies in order to have complete and accurate procedure authorizations and approvals.</li>
<li>Duty 4: Ability to professionally communicate to all patients and office staff, and meet age specific requirements for handling their requests.</li>
<li>Duty 5: Continue to stay informed of any statute and/or regulation that could affect Authorization requirements.</li>
<li>Duty 6: Work through the retro auth request lists, working with denials, and have the ability to timely address order/rad changes that may affect an authorization.</li>
<li>Duty 7: Acts as a liaison between the facility, patient/family and ordering provider to resolve problems and/or address complaints.</li>
<li>Duty 8: Participates in a variety of unit and hospital educational programs to maintain current skills and competency levels. Participates in and fully supports new hire and other department training and shadowing. Provides a positive learning environment and compassionate mentoring.</li>
<li>Duty 9: Has ability to problem solve and offers assistance as needed to all customer groups.</li>
<li>Duty 10: Performs all duties and responsibilities in a manner consistent with and supportive of the mission and value statement of Blanchard Valley Health System.</li>
</ul><p><b>
REQUIRED QUALIFICATIONS</b></p><ul>
<li>
High school graduate or GED equivalent</li>
<li>Data entry and/or PC experience required</li>
<li>Medical terminology coursework or knowledge required</li>
<li>BWC, VA, Medicare, Medicaid and commercial healthcare insurance knowledge</li>
<li>Positive service-oriented interpersonal and communication skills required</li>
<li>Individual must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patient served on his/her assigned unit/department. The individual must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient status. Must be able to interpret the appropriate information needed to identify each patient&rsquo;s requirements relative to their age-specific needs and to provide the care needed as described in the area&rsquo;s policies and procedures.</li>
</ul><p><b>
PREFERRED QUALIFICATIONS</b></p><ul>
<li>
Some related college preferred</li>
<li>Insurance verification and authorization submission/verification experience preferred</li>
<li>Knowledge of current EHR and insurance verification/authorization software</li>
<li>Ability to meet remote work requirements.</li>
</ul><p><b>
PHYSICAL DEMANDS</b></p><p>
This position requires a full range of body motion with intermittent walking, lifting, bending, climbing, squatting, kneeling, twisting, sitting and standing. The associate must be able to lift 20-30 pounds or more. The individual must have excellent eye-hand coordination with the ability to grasp, push and pull, have fine fingers dexterity and manipulation. The associate must be able to reach work above the shoulders. This position requires corrected vision and hearing in the normal range. The associate must have excellent verbal skills to communicate with patients, physicians, and co-workers.</p><p><b>
This position is classified &ldquo;at risk&rdquo; for possible occupational exposure to blood borne pathogens (HBV, HIV, etc.)</b></p></div>
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</div><div></div><div><h3 class="jobSectionHeader"><b>Job Snapshot</b></h3>
<div><h4 class="jobSectionHeader"><b>Employee Type</b></h4>
Per Diem
</div><div><h4 class="jobSectionHeader"><b>Street Address</b></h4>
1900 South Main Street
</div><div><h4 class="jobSectionHeader"><b>Location Map</b></h4>
</div><div><h4 class="jobSectionHeader"><b>Date Posted</b></h4>
03/10/2026
</div><div><h4 class="jobSectionHeader"><b>Job ID</b></h4>
19726
</div><div><h4 class="jobSectionHeader"><b>Shift</b></h4>
1st</div></div></div>

Patient Access Authorization Specialist (PRN)

DeCoach Recovery Centre

<div><div><p><b>Prior Authorization Specialist</b></p><p><b>
Job Description</b></p><div>
DeCoach Recovery is a leading addiction treatment center located in Sharonville, OH, dedicated to providing compassionate care and effective solutions for individuals battling addiction. We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our team.</div><p>
Job Overview: We are seeking a detail-oriented and energetic Prior Authorization Specialist to join our team. In this vital role, you will manage the authorization process for various medical services, ensuring timely approval from insurance providers. Your expertise will help streamline patient care, reduce delays, and enhance overall satisfaction by navigating complex managed care protocols with precision and professionalism.</p><p><b>
Key Responsibilities:</b></p><ul><li>
Review and prepare prior authorization requests for medical procedures, medications, and treatments</li><li>
Verify insurance coverage and eligibility through insurance verification processes</li><li>
Accurately code procedures using CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems</li><li>
Maintain comprehensive medical records and documentation in compliance with HIPAA regulations</li><li>
Communicate effectively with healthcare providers, insurance companies, and patients to facilitate authorization approvals</li><li>
Track and follow up on pending authorizations to ensure timely responses</li><li>
Stay current with changes in managed care policies, coding standards, and regulatory requirements</li></ul><p><b>
Qualifications:</b></p><ul><li>
Proven experience in managed care or medical office environments, preferably with prior authorization responsibilities</li><li>
Strong knowledge of medical terminology, medical records management, and medical coding (CPT, ICD-9, ICD-10)</li><li>
Familiarity with insurance verification processes and healthcare billing procedures</li><li>
Experience working in dental or medical offices is highly desirable</li><li>
Excellent organizational skills with attention to detail and accuracy</li><li>
Ability to navigate HIPAA regulations diligently to protect patient confidentiality</li><li>
Office experience demonstrating proficiency with electronic health records (EHR) systems or similar software</li></ul><p><b>
Benefits:</b></p><ul><li>
Competitive salary based on experience.</li><li>
Medical, Dental, &amp; Vision Heath Insurance</li><li>
Company Paid Life Insurance</li><li>
Affiliated with the STAR program, assist employees in paying off student loans</li><li>
Tuition Reimbursement program</li><li>
Paid Time-Off</li><li>
6 paid Holidays off</li><li>
Opportunities for Advancement</li><li>
Yearly Merit Raises</li></ul><p>
Join our dedicated team at DeCoach Recovery and contribute to our mission of providing quality addiction treatment services while ensuring financial sustainability through effective revenue cycle management. If you have the required skills and experience, we encourage you to apply and become part of our compassionate and dynamic team.</p></div><br>
8-4:30</div>

Prior Authorization Specialist

Physicians Revenue Group

<p><b>Job Type:</b> Full-Time | Onsite<br/><b>Shift Timing:</b> Night Shift (06:00 PM &ndash; 03:00 AM)<br/><b>Weekly Off:</b> Saturday &amp; Sunday<br/><b>Location:</b> Lahore</p><p><b>Job Overview</b></p><p>We are seeking an experienced <b>Authorization Specialist</b> to join our US healthcare operations team. The ideal candidate will have hands-on experience in prior authorization processes within the US healthcare system and a strong understanding of Revenue Cycle Management (RCM). This role requires excellent communication skills, attention to detail, and the ability to independently manage authorization workflows.</p><p><b>Key Responsibilities</b></p><ul><li>Handle end-to-end prior authorization processes for medical procedures, medications, and services</li><li>Verify patient insurance eligibility, coverage, and benefits</li><li>Submit authorization requests via insurance portals, fax, and outbound calls</li><li>Follow up with insurance companies to ensure timely approvals</li><li>Review and interpret payer guidelines for authorization requirements</li><li>Maintain accurate documentation and authorization records in the system</li><li>Coordinate with billing, coding, and clinical teams to resolve authorization-related issues</li><li>Manage denials related to authorization and initiate re-submissions or appeals when required</li><li>Track and report authorization status using MS Excel or internal systems</li><li>Communicate professionally with insurance representatives and internal stakeholders</li></ul><p><b>Eligibility &amp; Requirements</b></p><ul><li><b>Qualification:</b> Bachelor&rsquo;s degree (required)</li><li><b>Experience:</b> Minimum 1&ndash;3 years of experience in prior authorization / RCM (US Healthcare)</li><li>Strong command of English (spoken &amp; written)</li><li>Hands-on experience with insurance portals and authorization workflows</li><li>Proficiency in MS Excel (tracking, reporting, basic formulas)</li><li>Experience in handling calls with insurance companies</li><li>Must be a permanent resident of Lahore</li><li>Willingness to work night shift (US shift)</li></ul><p><b>Skills Required</b></p><ul><li>Strong communication and interpersonal skills</li><li>In-depth understanding of prior authorization processes</li><li>Analytical and problem-solving skills</li><li>High attention to detail and accuracy</li><li>Ability to manage workload independently and meet deadlines</li><li>Team-oriented with a professional attitude</li></ul><p><b>Why Join Us</b></p><ul><li>Fixed night shift with weekends off</li><li>Competitive salary based on experience</li><li>Growth opportunities in US healthcare and RCM</li><li>Structured processes and supportive work environment</li><li>Long-term career progression in medical billing</li></ul><p>Job Type: Full-time</p><p>Ability to commute/relocate:</p><ul><li>Lahore: Reliably commute or planning to relocate before starting work (Preferred)</li></ul><p>Education:</p><ul><li>Bachelor's (Preferred)</li></ul><p>Experience:</p><ul><li>Authorization Specialist: 2 years (Preferred)</li></ul><p>Work Location: In person</p>

Authorization Specialist

Onco360 Oncology Pharmacy

<div>
 <strong>
  Pharmacy Prior Authorization Specialist &ndash; Onco360 Pharmacy
  <br/>
  <br/>
 </strong>
 <em>
  Woodridge, IL
 </em>
 |
 <em>
  Full-Time
 </em>
 |
 <em>
  Starting at $23.00/hr and up
  <br/>
  <br/>
 </em>
 <strong>
  Join a mission-driven team making a difference in the lives of cancer patients.
  <br/>
  <br/>
 </strong>
 Onco360 Pharmacy is seeking a
 <strong>
  Pharmacy Prior Authorization Specialist
 </strong>
 to join our dedicated team in Woodridge, IL. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.
 <br/>
 <br/>
 <strong>
  Why Join Us?
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   A career with purpose: Help patients access life-saving medications.
  </li>
  <li>
   Supportive culture: We value teamwork, respect, integrity, and passion.
  </li>
  <li>
   Growth opportunities: We invest in your professional and personal development.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Company Benefits
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Medical; Dental; Vision
  </li>
  <li>
   401k with a match
  </li>
  <li>
   Paid Time Off and Paid Holidays
  </li>
  <li>
   Tuition Reimbursement
  </li>
  <li>
   Quarterly Incentive Bonus
  </li>
  <li>
   Paid Volunteer Day
  </li>
  <li>
   Referral Incentive Program
  </li>
  <li>
   Company Paid Life Insurance; and Short/Long-Term Disability
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What You&rsquo;ll Do
  <br/>
  <br/>
 </strong>
 The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
 <br/>
 <br/>
 <strong>
  How You&rsquo;ll Do This
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Manage prior authorization requests and appeals with insurance carriers.
  </li>
  <li>
   Collaborate with physicians, pharmacists, and other departments.
  </li>
  <li>
   Ensure HIPAA compliance while handling sensitive patient information.
  </li>
  <li>
   Maintain accurate documentation of authorization details.
  </li>
  <li>
   Proactively monitor and renew expiring authorizations.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What You Bring
  <br/>
  <br/>
 </strong>
 <em>
  <strong>
   Required:
   <br/>
   <br/>
  </strong>
 </em>
 <ul>
  <li>
   High School Diploma or GED
  </li>
  <li>
   1+ years of pharmacy or prior authorization experience
  </li>
  <li>
   Registration with Board of Pharmacy (as required by state law)
  </li>
  <li>
   Strong communication, organizational, and customer service skills
  </li>
  <li>
   Self-motivated, organized, detail-oriented, and adaptable to changing priorities
  </li>
  <li>
   Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred:
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Associate degree or Certified Pharmacy Technician (PTCB)
  </li>
  <li>
   3+ years of experience in pharmacy or prior authorizations
  </li>
  <li>
   Specialty pharmacy experience
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.
  <br/>
  <br/>
 </strong>
 <strong>
  #Company Values: Teamwork, Respect, Integrity, Passion
  <br/>
  <br/>
 </strong>
 #IH
</div>


Pharmacy Prior Authorization Specialist

61st Street Service Corporation

<div><p><b>Top Healthcare Provider Network</b></p>
<p>The 61st Street Service Corporation, provides administrative and clinical support staff for <b><i>ColumbiaDoctors</i></b>. This position will support ColumbiaDoctors, one of the largest multi-specialty practices in the Northeast. ColumbiaDoctors&rsquo; practices comprise an experienced group of more than 2,800 physicians, surgeons, dentists, and nurses, offering more than 240 specialties and subspecialties.</p>
<p><b>This position is primarily remote, candidates must reside in the Tri-State area (New York, New Jersey, or Connecticut).</b></p>
<p><b>Note: </b>There may be occasional requirements to visit the New York or New Jersey office for training, meetings, and other business needs.</p>
<p><b>Job Summary:</b></p>
<p>The Authorization Specialist III is responsible for verifying insurance policy benefit information, securing payer required authorization prior to the patient&rsquo;s visit, scheduled admission, or immediately following hospital admission. This position is responsible for obtaining accurate and timely pre-authorizations for professional services. The Authorization Specialist III is also responsible for assisting management with the daily work assignment, staff training, and quality audits.</p>
<p><b>Job Responsibilities:</b></p>
<ul><li>Verifies insurance coverage via system tools, payer portals (Electronic Query (Real-Time-Eligibility [RTE]/Insurance Payer Portal/Phone).</li>
<li>Upon verification of patient's insurance coverage, update changes in the billing system.</li>
<li>Confirms provider&rsquo;s participation status with patient&rsquo;s insurance plan/network.</li>
<li>Determines payer authorization requirements for professional services.</li>
<li>Research system notes to obtain missing or corrected insurance or demographic information.</li>
<li>Reviews clinical documentation to ensure criteria for procedure meets insurance requirements.</li>
<li>Initiates authorization and submits clinical documentation as requested by insurance companies.</li>
<li>Follows through on pre-certifications until final approval is obtained.</li>
<li>Manage faxes, emails, and phone calls. Responds to voicemails and emails.</li>
<li>Communicates with surgical coordinators regarding authorizations status or denials.</li>
<li>Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.</li>
<li>Set up peer to peer calls with clinical providers and insurance companies, as needed.</li>
<li>Calculate and document patient out of pocket estimates and provide to patient.</li>
<li>Assists Supervisor with special projects and/or tasks.</li>
<li>Assists Authorization Specialist I and II with complex cases or questions pertaining to the clearance of payer authorization or insurance eligibility issues.</li>
<li>Assist supervisor/manager with distribution of daily work assignments.</li>
<li>Assist with new-hire training and staff refresher training materials.</li>
<li>Monitor and replenish the unit&rsquo;s office supply needs.</li>
<li>Assist management team with performing periodic quality audits.</li>
<li>Performs other job duties as assigned.</li>
</ul>
<p>Please note: While this position is primarily remote, candidates must be in a Columbia University approved telework state. There may be occasional requirements to visit the office for meetings or other business needs. Travel and accommodation costs associated with these visits will be the employee's responsibility and not be reimbursed by the company.</p>
<p><b>Job Qualifications:</b></p>
<ul><li>High school graduate or GED certificate is required.</li>
<li>A minimum of 2 years&rsquo; experience in a physician&rsquo;s billing or third payer environment.</li>
<li>Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.</li>
<li>Candidate must demonstrate a strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and professional manner.</li>
<li>Must demonstrate effective communication skills both verbally and written.</li>
<li>Ability to multi-task, prioritize, document, and manage time effectively.</li>
<li>Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)</li>
<li>Functional proficiency and comprehension of medical terminology.</li>
<li>Certified Professional Coder certificate (CPC) is preferred.</li>
<li>Experience in Epic and or other of electronic billing systems is preferred.</li>
<li>Knowledge of medical terminology, diagnosis and procedure coding is preferred.</li>
<li>Previous experience in an academic healthcare setting is preferred.</li>
</ul>
<p><b>Hourly Rate Ranges: $27.88 - $36.06</b></p>
<p>Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.</p>
<p><b>61st Street Service Corporation</b></p>
<p>At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.</p>
<p>We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.</p></div>

Authorization Specialist III #Full Time #Remote

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