Authorization Specialists

Job Title

Essential Functions

• Monitor the authorizations of upcoming cases on physician's calendars ensuring authorization for office visits is obtained in a timely and accurate manner.
• Document authorizations and progress of authorizations in the patient's chart. Enter information within case management.
• Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing working relationships with both internal and external customers.
• Work with the department manager to respond to and reduce complaints timely and professionally.
• Ensure strict confidentiality of all health records, member information and meet HIPPA guidelines.

Required Skills/Abilities

• Effective in organization and billing requirements and authorization process
• Medical terminology.
• Skill in using computer programs and applications including Microsoft/ Excel, Microsoft Word and Outlook.
• Knowledge of insurance plans and procedures.
• Adherence to all policies and procedures, including standards for safety, attendance, punctuality, and personal appearance.
• Must be able to establish and maintain effective working relationships with management and peers.
• Ability to multitask in a fast-paced environment. Must be detailed oriented with strong organizational skills.
• Ability to work independently and demonstrate the ability to analyze data

Physical and Mental Demands

• Prolonged periods of sitting at a desk and working on a computer.
• Manual dexterity using a calculator, keyboard, photocopier, and other office equipment.
• Lifting of up to 15 pounds unassisted. Frequent bending, reaching, and repetitive hand movements standing, walking, squatting and sitting.
• Ability to view computer screens for long periods of time.

Duties/Responsibilities

• Contact the insurance company to see if authorization is needed for injections, images, in-office procedures, and visits.
• Obtain and document the authorization and benefit details and attach the information to claim for said dates of service.
• Work with Medical Assistants and advise them of the status of authorization.
• Maintain copies of the requests and the results by reference number and proof documents.
• Perform related work as required and other projects and duties as assigned.
• Assist in the insurance verification process as well as requesting referral authorization.
• Contact patients to obtain accurate insurance information.
• Participate in educational activities and attend monthly staff meetings.
• Maintain real-time authorization chats via Athena and Outlook.
• Responsible for medication sign out, order requests, and claim review.
• Orders, receives, and maintain inventory of drugs and ensures their security within the facility.
• Restock, label, collect, dispense and maintain inventory/ submission requests for medications.
• Keeping track of follow ups and schedule patients accordingly.
• Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.