Job Description
The Authorization and Benefits Specialist is responsible for obtaining benefits and preauthorization from payors, following up on authorization requests, obtaining retroactive authorizations, and maintaining authorizations for new patients.
JOB-SPECIFIC FUNCTIONS :
Responsibilities include initiating, following up, and securing benefits and authorizations sent to third-party payors.
Obtain authorization renewals
- Track and follow up on all pending authorizations at 3, 7,14, 30 days depending upon payer guidelines to expedite the claims process and avoid lost revenue
- Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations retrospectively and / or requesting single case agreements for out of network patients
- Work directly with providers to secure clinical notes and other supporting documentation required to obtain authorizations timely
- Verify authorization quantities and effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systems
- Create and maintain centralized payer master list to record requirements by payer
- Create a payer authorization manual and tips to securing authorization
- Identify opportunities to improve authorization efficiencies electronically
- Review and interpret insurance group pre-certification requirements, ensuring that proper pre-authorizations have been obtained from the payer and documented.
- Interact with patients and third-party insurance companies to secure retroactive insurance coverage and authorizations, and / or single case agreements for out of network patients
Qualifications
- Education : High School Diploma or GED required; some college preferred.
- Experience : A minimum of 2 years in benefit verification and authorizations preferred
- Skills : Communicates clearly and concisely, verbally and in writing, establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
- Ability to sustain prolonged sitting and extended computer use. Requires working under some stressful conditions to meet deadlines and to make quick decisions.
Require hand-eye coordination and manual dexterity.
Additional Information
Pay Range : $19-$21 per hour
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