Authorization Specialist | FT | Weekdays | Neurology Clinic | Memphis

About the Role

Responsible for precertification of eligible medical services and procedures for inpatient, diagnostic, and outpatient services. Ensures complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services. Models appropriate behavior as exemplified in the organization's Mission, Vision, and Values.

Responsibilities

• Perform precertification of eligible medical services and procedures for inpatient, diagnostic, and outpatient services based on medical plan documents and medical necessity.
• Manage pre-certifications for complex surgical and invasive procedures requiring strong clinical knowledge.
• Coordinate all documentation required for precertification of services.
• Establish and maintain good working relationships with physicians, physician office staff, patients, and other members of the healthcare team.

Requirements

• High School Diploma or Equivalent (required).
• 1-3 years of medical insurance authorizations and/or clinical experience (required).
• Licensed Practical Nurse (LPN) certification in Tennessee (preferred).

Skills

• Knowledge and experience in coverage practices, terminology, and requirements for referrals and authorization/pre-certification used by third-party payers, Medicare, and secondary payer rules.
• Knowledge of CPT, HCPCS, and ICD-10 codes (preferred).
• Demonstrated analytical ability to collect and interpret insurance and contract information.
• Experience dealing with PPO and Managed Care insurance.
• Strong attention to detail and critical thinking skills.
• Experience with a computerized healthcare information system (required).
• Familiarity with Microsoft Word software.
• Excellent verbal and written communication skills.

Physical Demands

• Light work: exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
• Physical activities may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
• Must have good balance and coordination.
• Close visual acuity required for activities such as preparing and analyzing data, transcribing, viewing a computer terminal, or extensive reading.
• Job functions are typically performed in general office or administrative conditions with minimal exposure to adverse environmental conditions.