Medical Authorization Specialist

Job Description

Job Description

At GI Associates we believe in striving for the best outcomes for our patients, employees, and community.

GI Associates is looking for motivated people to join our growing independent gastroenterology practice. Our nationally recognized physicians and dedicated team are patient-focused and provide compassionate, collaborative care to patients across Southeast Wisconsin.

GI Associates provides an excellent work-life balance and amazing benefits package including:

• No weekends
• No Holidays
• PTO & paid anniversary day
• 7% GI Associates retirement contribution & 401(k) plan
• Medical, dental & vision insurance
• Flexible spending plan
• Short- & long-term disability
• Basic & supplemental life insurance

Position summary

A Medical Authorization Specialist is responsible for determining insurance eligibility/benefits and ensuring pre- certification/referral requirements are met for both the facility and professional services.

Essential Duties & Responsibilities

• Monitoring and distributing faxes received internally for the department
• Works with patients to assist them with insurance requirements and coverages for care.
• Answers incoming calls to a phone queue in a timely, accurate and professional manner.
• Communicates with outside providers office, hospital staff, and independent facilities to obtain accurate insurance, authorizations and referrals.
• Verifies eligibility and benefit levels to ensure adequate coverage at correct site of service.
• Obtains pre-certification, authorization, and referral approval for required services for both the facility
• and professional services
• Ensures timely and accurate insurance authorizations/referrals are in place prior to services being rendered.
• Provides detailed documentation and communication with both payors and clinicians to obtain prior
• authorizations.
• Obtains and submits clinical information to support medical necessity.
• Coordinates peer-to-peer reviews, when required by payors.
• Completes accurate documentation in our practice management system.
• Assist with denials related to pre-certification as needed.
• Respond to internal/external emails and inquiries in a timely, accurate and complete manner.

Minimum Qualifications

• Works independently and efficiently, being able to prioritize the workflow
• Attention to detail
• Familiar with ICD-10 and CPT codes
• Familiar with Medical Terminology
• Communicates effectively and professionally

Physical & Mental Demands

• Able to sit, stand, walk, and reach throughout entire shift to accomplish tasks
• Able to push, pull, lift and/or move up to 20 lbs. occasionally
• Able to work through interruptions, managing multiple priorities in a fast-paced, dynamic environment
• Frequently uses a computer for typing and documentation; requires accurate and efficient data entry abilities
• Frequently uses the telephone to contact patients for communications

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