Authorization Specialist

Senior PsychCare Authorization Specialist

Senior PsychCare is hiring for an Authorization Specialist. The position is primarily responsible for obtaining required pre-authorizations and helping to process referrals for all services accurately and timely.

Essential Functions:

• Prioritize incoming authorization requests according to urgency
• Initiate, verify, and complete procedure authorization/referral process
• Resolves day-to-day issues pertaining to pre-authorization, as needed
• Monitor provider network status
• Obtain authorization by fax, payer website or by phone and follow up regularly on pending cases.
• Notify appropriate departments for approvals and denials
• Initiate and assist with appeals for denied authorizations
• Effectively maintain, monitor, and update payer medical policy guidelines to manage authorization requirements
• Request, review, and submit necessary patient documentation as needed to ensure approval of authorization
• Collaborate with healthcare providers and insurance companies to resolve any issues related to prior authorization
• Stay current with changing insurance policies and regulations
• Effectively utilizes ICD 10, CPT, modifiers, and/or other codes according to coding guidelines when requesting Authorizations
• Communicates effectively with the provider and/or all appropriate parties regarding missing information, such as CPT, diagnosis codes, documents, clinical reports, etc., to ensure proper authorization processing
• Communicates effectively with other departments regarding changes and/or updates with patient accounts and status
• Manages the status of accounts and identifies inconsistencies
• Responds to billing inquiries
• Uses downtime efficiently; is aware of team members' workload
• Makes recommendations on workflow improvement as needed

Knowledge, Skills, and Abilities:

• Knowledge of in and out of network insurance, insurance verification, and the process for prior authorization
• Familiarity with ICD-10 and CPT codes and procedures
• Ability to review and understand patient medical documentation
• Ability to independently identify and understand medical necessity requirements
• Task-oriented and organizational skills; ability to complete tasks in a timely manner
• Detail-oriented focus; being careful about detail and thorough in completing work tasks
• Ability to work independently and as a team
• Ability to adapt with flexibility
• Effective communication skills (written/verbal)

Education and Experience:

• High school diploma or GED
• Three (3) years authorizations experience with Managed Care Plans MCO's (Behavioral Health experience preferred)
• Strong working knowledge of insurance coverages and billing processes.
• Experience with basic desktop software, including Microsoft Office