RCM/OPH Insurance Authorization Specialist

Job Summary

The Intake Specialist – Insurance Authorization is responsible for timely, accurate and comprehensive review of patient schedules. Coordinates and effectively communicates with appropriate personnel regarding insurance carriers, business office services to ensure quality patient care and appropriate reimbursement. Also obtains the appropriate Pre-Authorization and Referral information, including verification of patient insurance, from physician offices and insurance carriers.

Duties and Responsibilities

• File requests for prior authorization for all insurances that require based upon plan or insurance contract
• Request, obtain, and document all prior authorizations (or denials of same) appropriately and in a timely manner
• Obtain information about patient insurance coverage, benefits and eligibility
• Maintain and update internal listing of insurance carriers that require authorization
• Run system-generated reports to verify procedures by insurances requiring authorization are being captured
• Assist collection team with obtaining retro authorizations
• Coordinate with Call Center and Optical Offices on prior authorization and patient billing activity
• Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service
• Performs other duties that may be necessary or in the best interest of the organization

Education, Licensure & Certification Requirements

High School Diploma or GED

Experience Requirements

2+ years' experience medical authorizations

Knowledge, Skills and Abilities Requirements

• Comprehensive understanding of insurance verification, contract benefits and medical terminology
• Ability to enter data into various electronic systems while maintaining the integrity and accuracy of the data
• Ability to function effectively under stress of conflicting demands on time and attention, while successfully meeting deadlines
• Excellent organization, time management, and prioritization skills
• Professional in appearance and actions
• Logical and Critical thinking skills
• Enjoys learning new technologies and systems
• Detail oriented, professional attitude, reliable
• Exhibits a positive attitude and is flexible in accepting work assignments and priorities
• Meets attendance and tardiness expectations
• Management and organizational skills to support the leadership of this function
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
• Interpersonal skills to support customer service, functional, and teammate support need
• Ability to communicate effectively in English, both verbally and in writing
• Ability to clearly articulate a response using appropriate voice modulation
• Ability to maintain control of a call de-escalating issues and instilling confidence that a resolution will be found
• Ability for basic to intermediate problem solving, including mathematics
• Basic to intermediate computer operation
• Proficiency with Microsoft Excel, Word, PowerPoint and Outlook
• Specialty knowledge of systems relating to job function
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Location/Work Environment

For on-site team members, work takes place in a normal office/clinical environment. Travel to other locations may be necessary to fulfill the essential duties and responsibilities of the job. Thus, those needing to travel for work must have access to dependable transportation, and their driving record must meet company liability carrier standards. For remote team members, HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused. Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives.