Authorization Specialist III #Full Time #Remote

Authorization Specialist III #Full Time #Remote 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. This position is primarily remote; candidates must reside in the Tri‑State area (New York, New Jersey, or Connecticut). Note: There may be occasional requirements to visit the New York or New Jersey office for training, meetings, and other business needs. Job Summary The Authorization Specialist III is responsible for verifying insurance policy benefit information, securing payer‑required authorization prior to the patient’s visit, scheduled admission, or immediately following hospital admission. This position obtains accurate and timely pre‑authorizations for professional services and assists management with the daily work assignment, staff training, and quality audits. Job Responsibilities Verifies insurance coverage via system tools and payer portals (Electronic Query, Real‑Time‑Eligibility, insurance payer portal, phone). Upon verification of patient’s insurance coverage, updates changes in the billing system. Confirms provider’s participation status with patient’s insurance plan/network. Determines payer authorization requirements for professional services. Researches system notes to obtain missing or corrected insurance or demographic information. Reviews clinical documentation to ensure criteria for procedures meet insurance requirements. Initiates authorization and submits clinical documentation as requested by insurance companies. Follows through on pre‑certifications until final approval is obtained. Manages faxes, emails, and phone calls; responds to voicemails and emails. Communicates with surgical coordinators regarding authorization status or denials. Submits appeals in the event of denial of prior authorizations or denial of payment following procedures. Set up peer‑to‑peer calls with clinical providers and insurance companies, as needed. Calculates and documents patient out‑of‑pocket estimates and provides them to the patient. Assists Supervisor with special projects and/or tasks. Assists Authorization Specialist I and II with complex cases or questions pertaining to payer 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. Assists management team with performing periodic quality audits. 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. Candidate must demonstrate a strong customer service and patient‑focused orientation and the ability to communicate, adapt, and respond to complex situations, including the ability to diffuse complex situations in a calm and professional manner. Must demonstrate effective verbal and written communication skills. Ability to multi‑task, prioritize, document, and manage time effectively. Functional proficiency in computer software (e.g., Microsoft Word, Excel, Outlook, email). Functional proficiency and comprehension of medical terminology. Certified Professional Coder (CPC) certificate is preferred. Experience in Epic or other 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: $27.88 - $36.06 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. The Service Corporation offers a competitive comprehensive benefit package to eligible employees, including healthcare and various other benefits such as 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. #J-18808-Ljbffr 61st Street Service Corporation