Insurance Authorization Specialist II

About the role

This position is responsible for obtaining authorizations for elective procedures, services, and tests to financially clear patients prior to services are rendered. Payor resources and any other applicable reference material such as payor and medical policies should be utilized to verify accurate prior authorization requirements.

Responsibilities

• Contact insurance company or employer to determine eligibility and benefits for requested services.
• Use work queues within the EPIC system for obtaining authorization for referrals, tests, and surgeries within expected timeframes.
• Follow up on submitted authorization requests timely.
• Audit and review medical record documentation to answer clinical questions during the authorization process.
• Schedule and follow up on peer-to-peer and denials.
• Submit and follow up on prior authorization appeals for denied surgeries.
• Assist Patient Financial Services with denial management issues and obtain retro-authorizations as needed.
• Notify scheduling and physicians of any cases not authorized within department policy.
• Maintain compliance with departmental quality standards and productivity measures.

Requirements

• High school graduate or equivalent with 2 years working experience in a medical environment, or Associate’s degree and 1 year of experience in a medical environment required.
• 3 years’ experience of knowledge and interpretation of medical terminology, ICD-10, and CPT codes.
• Understanding of authorization processes, insurance guidelines, and third-party payors.
• Proficiency in Microsoft Office applications.
• Excellent communication and interpersonal skills.
• Ability to prioritize to meet deadlines and multitask a large work volume with a high level of efficiency and attention to detail.
• Basic computer skills.

Qualifications

• High school graduate or equivalent with 2 years working experience in a medical environment, or Associate’s degree and 1 year of experience in a medical environment required.

Skills

• Knowledge of medical terminology.
• Practical knowledge of ICD-10 and CPT coding.
• Practical knowledge of third-party payors.
• General knowledge of time-of-service collection procedures.
• Basic knowledge of business math.
• Excellent customer service and telephone etiquette.

Benefits

N/A

Pay

N/A

Schedule

N/A