Medical Authorization Specialist

Position Summary

A Medical Authorization Specialist is responsible for determining insurance eligibility/benefits and ensuring pre-certification/referral requirements are met for both the facility and professional services.

Essential Duties & Responsibilities

• Monitoring and distributing faxes received internally for the department
• Works with patients to assist them with insurance requirements and coverages for care.
• Answers incoming calls to a phone queue in a timely, accurate and professional manner.
• Communicates with outside providers' offices, hospital staff, and independent facilities to obtain accurate insurance, authorizations, and referrals.
• Verifies eligibility and benefit levels to ensure adequate coverage at correct site of service.
• Obtains pre-certification, authorization, and referral approval for required services for both the facility and professional services.
• Sets up and ensures timely and accurate insurance authorizations/referrals are in place prior to services being rendered.
• Provides detailed documentation and communication with both payors and clinicians to obtain prior authorizations.
• Completes accurate documentation in our practice management system.
• Assist with denials related to pre-certification as needed.
• Responds to internal/external emails and inquiries in a timely, accurate and complete manner.

Minimum Qualifications

• Works independently and efficiently, being able to prioritize the workflow
• Attention to detail
• Familiar with ICD-10 and CPT codes
• Familiar with Medical Terminology
• Communicates effectively and professionally

Physical & Mental Demands

• Able to sit, stand, walk, and reach throughout entire shift to accomplish tasks
• Able to push, pull, lift and/or move up to 20 lbs. occasionally
• Able to work through interruptions, managing multiple priorities in a fast-paced, dynamic environment
• Frequently uses a computer for typing and documentation; requires accurate and efficient data entry abilities
• Frequently uses the telephone to contact patients for communications