What are the responsibilities and job description for the Insurance Authorization Specialist position at Advanced Urology Institute LLC?
Job Description
Job Description
Description : GENERAL SUMMARY
The Insurance Authorization Specialist handles all aspects of securing insurance authorizations for Urology services and procedures. This position will complete verification and prior authorizations of services, evaluate portion to be paid by the customer, and perform other insurance related assignments as directed.
ESSENTIAL JOB FUNCTION / COMPETENCIES
Responsibilities include but are not limited to :
- Submits requests for insurance eligibility and prior authorizations for all required insurances based upon plan or insurance contract for all upcoming appointments at designated intervals.
- Secures a referral or order from the physician, if necessary.
- Documents information in Practice Management (PM) system to include policy and group number, patient demographics, copays / deductibles, and coinsurance.
- Maintains and updates internal listing of insurance carriers that require authorization.
- Runs account audits to ensure that authorization is being obtained where needed.
- Obtains information about patient insurance coverage, benefits, and eligibility.
- Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicate relevant coverage / eligibility.
- Identifies patients who may need Medicare Advance Beneficiary Notices of Noncoverage (ABNs).
- Assists Business Office team with obtaining retro-authorizations.
- Coordinates with Call Center and Offices on prior authorization and eligibility activity as needed.
- Follows appropriate escalation procedures related to authorizations not obtained and contacts stakeholders when there is a threat to payment.
- Performs other position related duties as assigned.
CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS
KNOWLEDGE | SKILLS | ABILITIES
Requirements :
EDUCATION REQUIREMENTS
High School Diploma or equivalent required.
EXPERIENCE REQUIREMENTS
2 years experience working medical authorizations.
Comprehensive understanding of insurance verification, contract benefits, and medical terminology.
REQUIRED TRAVEL
N / A
PHYSICAL DEMANDS
Carrying Weight
Frequency
1-25 lbs.
Frequent from 34% to 66%
26-50 lbs.
Occasionally from 2% to 33%
Pushing / Pulling
Frequency
1-25 lbs.
Seldom, up to 2%
100 lbs.
Seldom, up to 2%
Lifting - Height, Weight
Frequency
Floor to Chest, 1 -25 lbs.
Occasional : from 2% to 33%
Floor to Chest, 26-50 lbs.
Seldom : up to 2%
Floor to Waist, 1-25 lbs.
Occasional : from 2% to 33%
Floor to Waist, 26-50 lbs.
Seldom : up to 2%
