Authorization-Referrals Specialist III #Full Time

Authorization-Referrals Specialist III

The 61st Street Service Corporation, provides administrative and clinical support staff for ColumbiaDoctors. This position will support ColumbiaDoctors, one of the largest multi-specialty practices in the Northeast. ColumbiaDoctors' practices comprise an experienced group of more than 2,800 physicians, surgeons, dentists, and nurses, offering more than 240 specialties and subspecialties.

The Authorization-Referrals Specialist III is responsible for verifying insurance policy benefit information, securing payer required referrals and authorization prior to the patient's visit, scheduled admission, or immediately following hospital admission. This position is responsible for obtaining accurate and timely pre-authorizations for professional services. The Authorization-Referrals Specialist III is also responsible for assisting management with the daily work assignment, staff training, and quality audits.

Job Responsibilities

• Verifies insurance coverage via system tools, payer portals.
• Confirms provider's participation status with patient's insurance plan/network.
• Determines payer referral and authorization requirements for professional services.
• Contacts patient and PCP to secure payer required referral for planned services.
• Documents referral in practice management system.
• Initiates authorization and submits clinical documentation as requested by insurance companies.
• Manages faxes, emails, and phone calls in a timely manner.
• Communicates with surgical coordinators regarding authorizations status or denials.
• Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
• Calculates and documents patient out of pocket estimates and provides to patient.
• Assists Supervisor with special projects and/or tasks.
• Assists Authorization-Referrals Specialist I and II with complex cases pertaining to clearance of payer referrals, authorization or insurance eligibility issues.
• Assists supervisor/manager with distribution of daily work assignments.
• Assists with new-hire training and staff refresher training materials.
• Monitors and replenishes the unit's office supply needs.
• Performs other job duties as assigned.

Job Qualifications

• High school graduate or GED certificate is required.
• A minimum of 2 years' experience in a physician's billing or third payer environment.
• Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
• Certified Professional Coder certificate (CPC) is preferred.
• Experience in Epic and or other of electronic billing systems is preferred.
• Knowledge of medical terminology, diagnosis and procedure coding is preferred.
• Previous experience in an academic healthcare setting is preferred.

Hourly Rate Ranges: $28.72 - $36.92

Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.

At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.

We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.