Authorization Specialist

POSITION DESCRIPTION: This position is responsible for all aspects of the authorization/pre-certification process. May perform Medical Receptionist duties as necessary. ESSENTIAL JOB FUNCTIONS: Obtains pre-certifications, insurance authorizations and testing for medical procedures. Monitors inbox. Obtains urgent authorizations same day, next day. Verifies correct procedural and diagnostic codes and insurance verification. Generates authorization information for physicians, patients and health plans. Acts as a liaison among providers, staff, health plan administrators and hospital representatives. Relays clinical information to health plan case managers for special procedure pre-certification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up as necessary. Communicates referral status to staff and physicians; ensures that authorizations have been processed accurately and in a timely manner to coincide with patient treatment plan. Assists offices in, resolving billing discrepancies and any other referral/authorization issues. Answers incoming calls. Scans and files documents. Supports other offices, attends required meetings and training, and participates in committees as requested. May perform Medical Reception duties as necessary. Assists with special projects and assumes additional duties as assigned. ESSENTIAL QUALIFICATIONS: EDUCATION : Undergraduate degree or Associate''s degree in health care or a related field and specialized training or equivalent combination of education and experience. CREDENTIALS/LICENSURE : None MINIMUM EXPERIENCE : 4 years'' experience with insurance referrals, prior authorization or other relevant medical office experience. POSITION REQUIREMENTS (ABILITIES & SKILLS): Knowledge of medical terminology and procedures at the level needed to perform responsibilities. Proficient knowledge of major health plans and insurance processes. Excellent written (legible), verbal and face-to-face communication skills, including ability to effectively explain relevant insurance information to patients, as well as communicate with insurance plans and internal customers. Proper phone etiquette. Proficient/knowledgeable in patient care procedures and organizational policies related to position responsibilities. Service-oriented; responsive to customer needs and courteous in approach. Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, NextGen , PowerChart , EPIC, Microsoft Word /Excel/Outlook, intranet and computer navigation. Ability to compute mathematical calculations. Ability to work independently and collaboratively in a team-oriented environment; professional and friendly demeanor. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, vendors, outside customers and couriers. Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations. Good organizational and time management skills to effectively juggle multiple priorities and time constraints. Ability to exercise sound judgement and problem-solving skills. Ability to handle patient and organizational information in a confidential manner. Ability to travel to other office/practice sites and meeting and training locations. Successful completion of IHA competency-based program within introductory and training period.

Created: 2021-11-29