Authorization Specialist

JOB DESCRIPTION SeniorPsychCareishiring foranAuthorization Specialist.The position isprimarily responsible for obtaining requiredpre-authorizations andhelping to processreferrals for all services accurately andtimely. ESSENTIAL FUNCTIONS Prioritize incoming authorization requests according to urgency Initiate,verify, and complete procedure authorization/referral process Resolves day-to-day issuespertaining topre-authorization, as needed Monitor provider network status Obtain authorization by fax, payer website or by phone and follow up regularly on pending cases. Notify appropriate departmentsfor approvals and denials Initiate andassistwith appeals for denied authorizations Effectivelymaintain, monitor, and update payer medical policy guidelines to manage authorization requirements Request, review, andsubmitnecessary patient documentation as neededto ensure approval of authorization Collaborate with healthcare providers and insurance companies to resolve any issues related to prior authorization Stay current with changing insurance policies and regulations EffectivelyutilizesICD 10, CPT,modifiers, and/or other codes according to coding guidelineswhen requesting Authorizations Communicates effectively with the provider and/or allappropriate partiesregardingmissing information, such as CPT,diagnosis codes, documents, clinical reports, etc., to ensure proper authorization processing Communicates effectively with other departmentsregardingchanges and/or updates with patient accounts andstatus Manages the status of accounts andidentifiesinconsistencies Responds to billing inquiries Uses downtime efficiently; is aware of team members' workload Makes recommendations on workflow improvement as needed KNOWLEDGE, SKILLS, AND ABILITIES Knowledge of in and out of network insurance, insurance verification, and the process for prior authorization Familiarity with ICD-10 and CPT codes and procedures Ability to review and understand patient medical documentation Ability to independentlyidentifyand understand medical necessity requirements Task-oriented and organizational skills; ability to complete tasksimely manner Detail-oriented focus; being careful about detail and thorough in completing work tasks Ability to work independently and as a team #J-18808-Ljbffr