Authorization Specialist

Job Description

Job Description

Position Summary/Scope of Responsibility

The Centers for Advanced Orthopaedics LLC (CAO) is one of the nation’s largest Orthopaedics practices, owned and operated by physicians, with over 60 locations across Maryland, Northern Virginia, and the District of Columbia.  With approximately 2,000 employees, working in 28 Divisions, CAO is a growing business with revenues of approximately $250 Million. CAO is committed to be the Orthopaedics provider of choice for our patients; partner of choice for payors and health systems; and employer of choice by attracting and retaining a talented workforce.

The Scheduler and Authorization Specialist is responsible for performing a variety of patient registration, scheduling, and insurance verification duties. Answers phone calls from patients with professionalism and efficiency to get them registered and scheduled. Responds to routine inquiries regarding online and in office scheduling. Drives requests, tracking, and obtaining of pre-authorization from insurers within time allotted for medical and therapy services being performed. Significant understanding of benefits and prior authorization as well as excellent multi-taking skills and attention to detail are paramount to complete the many aspects of this role.

Duties include, but are not limited to:

1. Contribute to the achievement of excellence in health care to fulfill the mission of the unit.
2. Exhibit strong and care-focused customer service skills in daily interaction with the public, patients, staff, and physicians in the performance of job duties.
3. Scheduling, changing, and updating patient appointments.
4. Interview patients for demographic information, evaluate eligibility, collect co-pays, deductibles, including but not limited to insurance verification.
5. Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.
6. Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and Therapy services.
7. Process insurance authorizations and update patient records.
8. Research referrals to deny or approve based on information obtained and appropriately identify diagnosis (CPT and ICD-10 coding).
9. Operate online insurance verification websites.
10. Communicate any insurance changes or trends among team.
11. Respond to patient inquiries, questions, and scheduling requests.
12. Participate in department's Performance Improvement activities.
13. Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
14. Educate patients and coworkers on preauthorization process and assist with understanding coverage information. 
15. Utilize computer software programs, as needed, to communicate and understand patient needs (i.e. scheduling, EMR, etc.)
16. Report all necessary information and/or unusual occurrences in accordance with established policies and procedures.
17. Participate in orientation programs.
18. Ensures consistent compliance with all regulatory and CAO guidelines, policies, and procedures.
19. Performs other duties as assigned.

Required Education & Experience

• High School Diploma or equivalent.
• 1 – 2 years of medical office experience is preferred.
• Proficient knowledge in medical terminology.
• Above average spelling and typing skills needed.
• Proficient computer software (Online insurance websites and DASH) and database skills.
• Proficiency with Microsoft Office suite of products.
• Experience collaborating across multiple functions.
• Experience innovating in a fast-growing work environment and dealing with ambiguity.

Competencies/Required Skills & Abilities

• Strong Interpersonal Skills - Ability to develop relationships and collaborate and influence in a decentralized organization.
• Demonstrated ability to organize, prioritize, and manage multiple tasks in a dynamic environment with a proven track record of results.
• Strong oral and written communication skills with excellent self-discipline and patience.
• Able to work independently.
• Excellent time management, organization, and administrative support skills.
• Must be able to read, write, speak, understand, and communicate in the English language.

Physical Demands

• Must be able to sit for long periods of time and lift up to 25 pounds.  
• Must be able to use appropriate body mechanics techniques when performing desk duties.  
• Requires frequent bending, reaching, repetitive hand movements, standing, walking, squatting, and sitting.
• Adequate hearing to perform duties in person and over telephone.
• Must be able to communicate clearly to patients in person and over the telephone.
• Visual acuity adequate to perform job duties, including reading materials from printed sources and computer screens.