Spec Authorization

Responsibilities

Verifies patient insurance coverage timely utilizing phone or online resources.

Submit prior authorizations to insurances in timely matter via payer specific portals and vendors

Ensures all pertinent medical documentation is accurate and present prior to authorization submission.

Follows up with pending authorizations on a regular basis to obtain the current status or to be informed of any action needed in order to obtain the authorization approval.

Communicates any authorization denials to the appropriate staff.

Handles any discrepancies, errors, or omissions of authorization denials and files appeals when necessary for overturn of adverse decision.

Participates in educational activities and attends regular staff and department meetings.

Exhibit and manage excellent turn-around time in order to ensure timely authorizations.

Consistently work in a positive and cooperative manner with fellow team members and management.

Demonstrate flexibility to perform duties wherever volume deems it necessary.

Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner.

Document activities appropriately in process notes.

Participates in the Quality Assurance plan.

Complies with applicable CLIA and HIPAA regulations.

Stay up to date with SOPS

Complies with all company and department policies and procedures

Contributes to a positive work and team culture

Qualifications

High school diploma or GED equivalent required

3-5 years of experience working in medical billing, health insurance or collections with demonstrated results preferred.

Insurance billing experience is preferred.

Good problem solving and decision-making skills.

Excellent customer service and phone skills.

Excellent time management, organizational, communication, multitasking and teamwork skills.

Working knowledge of ICD-10, CPT and HCPCS coding (preferred but no required).

Ability to successfully navigate between multiple systems throughout the course of the workday this includes but is not limited to billing software, written Standard Operating Procedures and payer portals.

Preferred authorization experience

Physical & Lifting Requirements

Lifting Requirements - light work or exerting up to 20 pounds of force frequently.

Physical Requirements - stationary positioning, moving, operating, ascending / descending, communicating and observing.

Use of equipment and tools necessary to perform essential job functions.

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