Medical Authorization Specialist II

Key Responsibilities

• Verify patient benefits and calculate patient’s estimated financial responsibility.
• Review insurance carrier policies to understand the nuances of various payers’ coverage requirements for the company’s products.
• Review and interpret medical record documentation, such as patient history summaries, surgical notes, and treatment plans, to ensure an order meets requirements for insurance policy coverage.
• Identify missing medical record documentation and communicate with company personnel to secure additional information as needed.
• Submit pre-authorization requests with required demographic and clinical documentation in a timely manner to avoid delays in patient treatment.
• Regularly and persistently communicate with insurance carriers to ensure timely processing of pre-authorization decisions.
• Maintain complete, timely, and accurate documentation in the order processing system.
• Attend team and department meetings and events.
• Always operate compliantly by keeping patient data secure and confidential.
• Comply with all health, safety and environmental policies, procedures, and job hazard analyses applicable to specified job activities, including medical evaluations as required by job function.
• Complete all required training in a satisfactory and timely manner.
• Hold oneself and others accountable to conduct business in a manner compliant with Bioventus’ Code of Compliance, policies and procedures and internal controls applicable to the role.

Requirements

• In lieu of a degree, at least 2 years of medical authorization experience involving reviewing and interpreting medical records.
• Successful completion of Exogen Certification.
• Strong organizational skills: ability to manage detailed information, multi-task, manage time effectively, and prioritize appropriately.
• Excellent written and oral communication skills with the ability to interface with customers, insurance providers, and company personnel at all levels.
• Strong problem-solving skills and professional persistence.
• Proficient using Microsoft Word, Excel, Outlook, and other department software.
• Experience reviewing insurance plan policies across various insurers.
• Experience verifying patient benefits and calculating estimated financial responsibility.
• Familiarity with bone and fracture medical terminology.
• Medical coding certification and/or experience with ICD-10 coding (strongly preferred).