Authorization Specialist

JOB DESCRIPTION SeniorPsychCareishiring foranAuthorization Specialist. The position is primarily responsible for obtaining required pre-authorizations and helping to process referrals for all services accurately and timely. ESSENTIAL FUNCTIONS Prioritize incoming authorization requests according to urgency Initiate, verify, and complete procedure authorization/referral process Resolve day-to-day issues pertaining to pre-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 departments for approvals and denials Initiate and assist with appeals for denied authorizations Effectively maintain, monitor, and update payer medical policy guidelines to manage authorization requirements Request, review, and submit necessary patient documentation as needed to 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 Effectively utilize ICD 10, CPT, modifiers, and/or other codes according to coding guidelines when requesting Authorizations Communicates effectively with the provider and/or all appropriate parties regarding missing information, such as CPT, diagnosis codes, documents, clinical reports, etc., to ensure proper authorization processing Communicates effectively with other departments regarding changes and/or updates with patient accounts and status Manages the status of accounts and identifies inconsistencies 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 independently identify and understand medical necessity requirements Task-oriented and organizational skills; ability to complete tasks in a timely manner Detail-oriented focus; being careful about detail and thorough in completing work tasks Ability to work independently and as a team Ability to adapt with flexibility Effective communication skills (written/verbal) EDUCATION AND EXPERIENCE High school diploma or GED Three (3) years authorization experience with Managed Care Plans MCO’s (Behavioral Health experience preferred) Strong working knowledge of insurance coverages and billing processes. Experience with basic desktop software, including Microsoft Office #J-18808-Ljbffr