Authorization Specialist

About the role

The Authorization Specialist at OSS Health is responsible for verifying benefits/eligibility and obtaining authorizations for patients' medical services. This position serves as a liaison between the clinical team, providers, external facilities, and patients.

Responsibilities

• Screens and analyzes patient medical records for medical necessity documentation.
• Obtains patients’ benefit information from insurance companies.
• Familiarizes self with medical policies and criteria for each insurance company.
• Follows up with the doctor’s team for additional information if needed.
• Reviews clinical documents with Nurse Reviewers and/or Utilization Managers.
• Collaborates with other OSS department staff, external facility staff, and external companies to ensure authorization/referrals are obtained.
• Communicates with external locations to ensure shipment of injections to OSS.
• Ensures authorization is secured with the insurance company before scheduled services.
• Obtains authorization timely when required prior to scheduling.
• Contributes to team training initiatives.
• Communicates with physician’s team regarding unsuccessful pre-certification/authorization processes.
• Documents the process in EMR systems for future reference and claims processing.
• Addresses concerns of insurance companies and patients professionally and calmly.
• Maintains an orderly and neat work area.
• Maintains confidentiality and protects sensitive data.
• Maintains performance in alignment with audit standards.
• Creates and modifies vendor reports.

Requirements

• High School Diploma or equivalent required.
• Licensed Practical Nurse (LPN) or certified Medical Assistant (MA) preferred.
• One-year relevant experience in the medical field or in prior authorization required.
• Basic knowledge and understanding of CPT/ICD10 codes for insurance verification.
• Basic knowledge and understanding of medications, advanced imaging studies, and surgical procedures.
• Strong clinical knowledge and understanding of medical terminology and anatomy.
• Orthopedic knowledge preferred.
• Proficient computer skills, including Microsoft Office, and basic office equipment usage.
• Detail-oriented, excellent organizational and prioritizing skills, and ability to meet competing deadlines.
• High level of analytical skills and critical thinking.
• Excellent communication skills, both written and verbal.
• Good telephone etiquette and ability to answer phones and direct calls appropriately.
• Flexibility to adapt to new and changing duties to meet patient needs effectively and efficiently.

Qualifications

• Education: High School Diploma or equivalent.

Skills

• Medical Terminology
• Anatomy
• CPT/ICD10 Codes
• Medications
• Advanced Imaging Studies
• Surgical Procedures
• Insurance Verification
• Communication Skills
• Computer Skills (Microsoft Office)

Benefits

• Competitive Wages
• Medical, Dental, Vision coverage on the first day of employment
• Disability, and Life Insurance within 90 days
• Company-Paid Group Life Insurance
• Short-Term Disability & Long-Term Disability
• Paid Time Off (PTO)
• 401(k) plan and profit sharing
• Career Advancement Opportunities