Authorization Specialist

Authorization Specialist

The Authorization Specialist is assigned patients to obtain insurance to determine if an authorization is required for the testing/procedure being ordered by the requesting physician/practitioner. The Authorization Specialist will check patient demographics and more importantly insurance information to ensure Conway Medical Center has the most up-to-date information for accurate reimbursement submission.

Qualifications:

• Education: High School Diploma required.
• Experience: Two (2) years experience in hospital and/or physician billing/pre-authorization or insurance verification.
• Demonstrated knowledge of health insurance plans including: Medicare; Medicaid, HMOs; and PPOs required.
• Familiarity with electronic health records (E.H.R.) and documentation requirements and accessibility.
• Knowledge of online insurance eligibility and insurance verification systems.
• Licensure/Certification/Registration: Medical Terminology certification preferred. Certification or Associate degree in ICD-10-CM/ICD-10-PCS; CPT, HCPCS preferred Certified Health Access Associate credential preferred.

Duties and Responsibilities:

• Collaborates with designated clinical contacts that require escalation to peer-to-peer review.
• Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals.
• Educate and counsel patients on their insurance coverage and explain payment options that are available to them.
• Work with front line staff to ensure collections are secured at time of presentation.
• Always displays exemplary core customer service skills.
• Consistently display effective verbal and written communication skills.
• Proficient understanding and use of technology/PC skills required.
• Work well in a fast-paced environment; efficiently organize work and maintain a high level of accuracy and productivity.
• Complete other duties as assigned by department leadership.