Verification/Authorization Specialist

Job Description

Job Description

Company Description

Metro Physical & Aquatic Therapy is a comprehensive multidisciplinary company who offers Physical, Occupational, Speech Therapy, Massage and Acupuncture services. We take great pride in inspiring our team to create an everlasting bond with our patients, our doctors, and our community. But it’s not just what we do, it’s who we are. We are driven by our mission to continually invest in our people and offer the best workplace environment possible.

The role responsible will be responsible for all aspects of the prior authorization process. Responsibilities include collecting all the necessary documentation, contacting the client for additional information and completion of the required prior authorization in order to proceed with testing. Complete, timely, and accurate identification and submission of prior and retro authorization requests to the payors. Interacts with clients, insurance companies, patients, and sales representatives, as necessary, to request for prior authorizations.

Essential Functions:

1. Ensure all pre-authorizations have been approved with the proper procedure code prior to service being rendered. In addition, have the ability to work with technology necessary to complete a job effectively.

2. Ensure that ICD10 diagnosis codes are entered by all Therapists correctly.

3. Input authorizations and updating miscellaneous screens to ensure authorizations are processed.

4. Provides data entry for proper level of care which has been arranged by the Authorization received from funding sources.

5. Contacts providers and patients with authorization, denial, appeals process information, and provides other therapy options.

6. Maintain robust documentation of authorization processes and procedures.

7. Assist patients, site staff, and management with authorization issues.

8. Collaborates with other departments to receive and process authorization forms.

9. Uses good documentation skills to document process and procedure as well as conversations with clients and insurance carriers.

10. Generate “expected collections” report to notify patients of cost responsibilities. In addition, make corrections on patient accounts when errors are identified.

11. Maintain referred physician National Provider Identifier (NPI).

12. Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

13. Performs other duties and assignments as required.

High school diploma or GED is required.

3 years of experience in the field or in a related area.

Strong customer service skills; ability to diffuse client frustrations.

Current or recent experience in a medical practice ensuring compliance with federal, state and local regulations and guidelines.

Must work well within a team environment.

Excellent interpersonal and communication skills

Proficiency in Word, Outlook, and Excel.

Ability to use logic and problem-solving skills to resolve issues, and navigate between dual monitors.

Ability to work independently under tight deadlines in a rapidly changing environment.

Ability to handle stressful situations resulting from high volume of phone calls, technical problems, frustrated customers and changes in departmental priorities or procedures.

Good organizational and multitasking skills.

What We Offer!

• Competitive compensation package
• 401(k) plan with company matching options
• Generous Paid Time Off
• A rich benefits package, including medical, dental, life and long-term disability insurance
• Progressive Leadership Development Programs
• New York's 529 College Savings Program
• Employee Perks: discounted rates for entertainment, travel, fitness, insurance plans, etc. through our partnership with Plum Benefits
• FSA Plans- pre tax savings plans to pay for unreimbursed medical and dental expenses, travel to & from work
• Company Events- Annual Family Field Day, Leadership Retreats, and Holiday Awards Celebration
• And much more!