Insurance Authorization Specialist

Facility : OrthoIndy Northwest, Indianapolis, IN
Department : Support Services
Shift Details : Days, Full Time, Mon-Fri

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General Statement of Duties:


The Insurance Authorization Specialist verifies insurance coverage and obtains insurance authorization prior to procedures, including; surgical and interventional pain management procedures. The Specialist is responsible for providing accurate and complete data input into multiple electronic systems for precertification requests, and for maintaining multiple online accounts to ensure immediate access. The position navigates complex online and telephonic insurance systems in a timely manner and manages frequent interruptions and prioritizes work in a dynamic fast paced work environment. The Specialist notifies the appropriate departments if insurance coverage is incorrect and obtains and inputs corrected insurance information as needed and follows established policies and procedures in order to manage various insurance denial situations.


Essential Duties:

1. Verifies active insurance status and network information for each patient. Submits required information to insurance companies for precertification and authorization. Monitors authorizations to minimize last-minute insurance denials. Proactively acts to provide additional clinical information to insurance ensure companies receive all available documentation as needed. Confirms receipt of all necessary preauthorization documents before procedures. Annotates steps completed on surgery orders and downloads authorization documentation into the practice management program for future reference. Utilizes practice management tools to indicate admit status (inpatient or outpatient), the number of days approved, CPT codes approved, effective date, expiration date, and all authorization numbers to ensure accurate flow of information from authorization department to hospital admissions and case management. Takes necessary steps to correct or cancel procedure if preauthorization information is missing or incorrect. Communicates next steps to appropriate teams if additional action is needed outside the authorization department.
2. Provides insurance authorization audits and updates for the revenue cycle team related to insurance denials each month.
3. Serves as a point of contact for assigned Physicians and employees. Maintains rapport with Physicians, private staff, and coworkers to ensure excellent communication and satisfaction. Handles phone calls, tasking, and messages in the electronic medical record related to the scheduled medical procedure's insurance authorization process.
4. Provides updated clinical documentation from ordering provider or preadmissions testing if additional medical necessity documentation is required to obtain authorization.
5. Pre-operatively notifies ordering surgeon's team if insurance authorization does not include all CPT codes submitted or if insurance denies ordered admit status. Takes appropriate steps to verify ordering surgeon received notification. Also, confirms admit status and insurance authorization match in EHR and practice management systems.
6. Develops and supports effective communication with other employees, professional support staff, customers, patients, families, and providers to ensure patient satisfaction.
7. Support departmental and corporate strategic plans and ensure successful implementation.
8. Support company and department quality assurance initiatives and goals.

Requirements:

• High School Diploma/GED required; Bachelor's degree preferred
• Specialty training beyond high school required; I.e. Medical office certification and/or some college
• Knowledge and experience related to ICD-10, CPT, medical terminology, or insurance clinical guideline requirements required
• 4-6 years of related experience required; 6-8 years preferred

OrthoIndy is an Equal Opportunity Employer