Authorization Specialist

Authorization Specialist (Hybrid)

The Authorization Specialist is responsible for ensuring that services requiring authorization are provided to patients in compliance with all insurance and regulatory requirements. The Authorization Specialist will be responsible for communicating with insurance companies to obtain necessary authorizations for medical devices, managing patient medical records, and ensuring that services are provided and authorized within established guidelines.

Job Responsibilities:

Authorizations (60%)

• Communicate with insurance companies to obtain prior authorizations for medical procedures.
• Compile and maintain patient medical records in accordance with legal and regulatory requirements.
• Review patient medical records and insurance documentation to ensure that services provided are authorized.
• Follow up with insurance companies to ensure that authorizations are obtained in a timely manner.
• Document all communication related to the authorization process in patient medical records.
• Resolve technical errors on authorizations with payers.
• Maintain up-to-date knowledge of insurance companies' regulations and guidelines related to DME services.
• Coordinate with healthcare teams and/or customers to obtain information required by the insurance payer in order to obtain an authorization.
• Ensure insurance authorization-related tasks are performed accurately, efficiently, and timely to meet department and company goals.
• Work with Configuration to update or create authorization forms when needed.
• Support Operational Projects as directed.

Customer Service (20%)

• Handle incoming and outgoing calls from internal and external team members and insurance payers to create a remarkable experience to help maximize reimbursement and business opportunities.
• Maintain relationships with insurance providers that facilitate a positive partnership.
• Work with online portals and the insurance company to establish the most efficient method of obtaining the authorizations.

Documenting and Reporting (10%)

• Develop and maintain working knowledge of current durable medical equipment (DME) products offered by the company and all applicable insurance guidelines as it relates to eligibility for coverage and reimbursement.
• Ensure insurance-related tasks are performed accurately, efficiently, and timely to meet department and company goals.
• Report recurring payer issues or changes.
• Update TIMS as needed regarding billing rules, documentation rules, and payor policy changes when notified.

Other (10%)

• Collaborate with external and internal team members and customers to create a remarkable experience for our customers, maximize reimbursement, and business opportunities.
• Cross-train within the department to ensure smooth workflow and functional coverage.
• Participate in department meetings, HIPAA training, and other training sessions as required.
• Understand and comply with all applicable company policies and procedures.
• Comply with all applicable local/state/federal regulations related to the medical device and durable medical equipment industries.
• Perform other related duties as directed by the supervisor.

Requirements:

• Minimum required Education: High School Diploma, GED, Vocational Education or equivalent.
• Minimum required Experience: No prior experience required.
• Additional Qualifications: * Demonstrated superior customer service skills. Excellent communication skills, both verbal and written. Strong analytical and problem-solving skills. Ability to organize and prioritize workload. Ability to work independently and as part of a team. Strong knowledge of Microsoft Office products (Outlook, Word, and Excel).
• Physical Requirements: Must be able to sit at a desk in front of a personal computer (PC) monitor for long periods of time. Position requires incumbent to use a PC, telephone, and basic office equipment. This position requires the candidate can conduct telephone conversations, read medical and insurance information, and communicate clearly with all internal and external customers.

Preferred Qualifications & Skills:

• Preferred Experience: 2 years of experience working for or with medical insurance companies in a healthcare setting, preferably in an authorization role. Durable Medical Equipment (DME) experience preferred.
• Preferred Skills: * Troubleshooting Customer Relationship Management (CRM) Software Documentation & Reporting Customer Response Management Customer Service Software Quality Specifications Telephonic Systems Management Digital Literacy

Axelon Services Corporation