Pre-Authorization Specialist

Job Description Pre-Authorization Specialist Job Description (Hybrid role): Obtain pre-authorizations for gastro procedures (colonoscopy, endoscopy, ERCP, capsules, etc.) – they will need to understand CPT and ICD codes. Must have a comprehensive knowledge of insurance carrier policies and procedures – insurance will often provide incorrect/misinformation (such as no authorization required). They must have the knowledge to push back and question what they’re told. Our company policy is they must be two weeks ahead of the scheduled procedures as authorization requests can be delayed/take longer than expected – this requires speed. Eligibility verification for all patients being seen each day using various portals – our EMR (ECW), Navinet, Availity, E‑tactics, etc. We are a very busy practice – they need to have an element of speed to keep up with the eligibility and authorization requests. The ability to comprehend and explain patient benefits – deductibles, coinsurance, copays, any patient responsibility. They will be calling patients to explain these benefits prior to their procedures – they need to have an element of customer service and be able to explain and answer questions regarding patient benefits/financial responsibility. The ability to effectively communicate with providers, staff, and patients – both written and oral. They will be sending many emails to providers and staff regarding authorization requests, they are also communicating with patients regularly. They will be a representation to both our doctors and patients and must present themselves professionally. #J-18808-Ljbffr 6AM City, LLC