Authorization Specialist
Integrated Pain Associates · Killeen, TX · 1 mo ago
On-siteOTHRFull-time
Duties And Responsibilities
- Respond to all work correspondence in a courteous and professional manner
- Utilize EMR system fax line and pull reports and patient records for department
- Obtain prior authorization through insurance portals and external authorization departments based on provider orders
- Insurance verification
- Review clinical documentation to ensure it supports the insurance requirements for approval
- Completion of appeals and processing Peer to Peer Requests for denied procedures
- Direct all communication and concerns to direct supervisor
- Copy appropriate recipients on all work-related emails and EMR telephone encounters
- Accurately notate accounts with actions taken as it relates to prior authorizations, follow ups, and scheduling
- Process all orders within a reasonable timeframe and continually check status for updates
- Maintain high priority tasks, messages, emails daily and throughout the day
- Format all authorization documents correctly and verify for accuracy prior to submission
- Notify appropriate departments in advance of any issues that may arise regarding authorization submission
- Additional tasks assigned by Supervisor or Executive Management
Required Skills/Abilities
- Two (2) years of prior authorization experience
- Previous knowledge/experience processing outgoing referrals
- Knowledge of CPT and ICD10 codes
- Strong, professional communication skills
- Positive attitude and adaptable to change
- Strong internal and external customer service skills
- Basic medical terminology
- Knowledge of HIPAA and Patient Rights guidelines
- Ability to follow all Federal, State and Local regulations
- Ability to enter data professionally into the Glo EMR system
Education and Experience
- High school or equivalent
- CPT and ICD10 Code: 1 year
- ECW EMR system: 1 year
- Insurance Eligibility and Authorization portals such as Availity, Carelon, Evicore: 1 year
- Specialty practice experience: preferably in pain management but not required
- Bilingual, a plus, but not required