Insurance Authorization Specialist

Job Description

Job Description

Salary :

VSI (formerly the Virginia Spine Institute), the leading multidisciplinary spinal healthcare practice in the Washington D.C. metropolitan area, is seeking an Insurance Authorization Specialist to join our team. This role is responsible for obtaining prior authorization for various medical procedures, services, and medications.

This is a full-time position working out of our Reston office. The position offers competitive pay, full benefits, 401k plan with a Company match, and three weeks of paid time off. The ideal candidate will have exceptional customer service skills and phone etiquette.

Duties & Responsibilities

• Responsible for facilitating prior authorization for a variety of services (surgery, injections, medications, imaging, etc.) in a timely manner and working efficiently to facilitate a final approval.
• Ensures all pertinent medical documentation is accurate and complete prior to authorization submission.
• Coordinates with workers' compensation case managers to streamline authorizations for care
• Tracks and monitors prior authorization status throughout the insurance approval process.
• Utilizes a thorough working knowledge of insurance plans and medical policies to complete prior authorization requirements.
• Coordinates with clinical staff during the prior authorization process to include notification of prior authorization approvals and denials in addition to facilitating appeals and peer-to-peer reviews with the payer.
• Responsible for insurance benefits verification.
• Works directly with the Director of Billing to identify trends in denials and opportunities for improvement in the authorization process.
• Provides superior customer service when communicating with patients to resolve all inquiries regarding insurance authorization requirements.

Skills / Qualifications / Behaviors :