Authorization Clerk

Description

 EDUCATION & EXPERIENCE: Any combination equivalent to the experience and education that is required by Federal, State, and/or Local guidelines. The minimum requirements for experience and education are:

• Education equivalent to graduation from High School; additional training in healthcare sciences is a plus.
• 2 - 5 years recent experience with utilization review and medical authorizations
• Familiarity with insurance authorization processes and medical terminology
• Certified Professional Coding certificate a plus.

REQUIREMENTS:

• Must be able to work a full-time schedule 
• Must be able to pass all pre-employment screening (background check, drug tests, and references)
• Must comply with organizational behavioral standards 
• Must attend basic orientations prior to independently working 

RESPONSIBILITIES:

• Authorization      Management:
  • Review patient records to identify services requiring prior authorization.
  • Submit prior authorization requests to insurance companies and follow up as needed.
  • Track and monitor the status of authorizations, ensuring timely approvals.
• Communication:
  • Collaborate with medical staff to gather necessary documentation for authorization requests.
  • Act as a liaison between patients, providers, and insurance companies to resolve authorization issues.
  • Notify patients and providers of authorization approvals or denials promptly.
• Documentation      and Record Keeping:
  • Maintain detailed and accurate records of authorization requests, responses, and outcomes.
  • Update patient files and the electronic health record (EHR) system with relevant authorization information.
• Compliance:
  • Stay updated on insurance policies, coverage criteria, and authorization procedures.
  • Ensure all activities comply with healthcare regulations, privacy laws (e.g., HIPAA), and organizational policies.
• Problem  Resolution:
  • Investigate and resolve authorization denials or delays by contacting insurance providers and appealing decisions as necessary.
  • Address and resolve patient or provider inquiries related to authorizations.

  QUALIFICATIONS:Knowledge base:

• Principles, practices and procedures of medical billing
• Medical billing codes such as ICD-10, CPT, and HCPCS 
• Medical terminology
• Strong communication and interpersonal skills.
• Proficiency in HER systems, authorization portals, and office software. 
• Knowledge of  HIPPA Privacy Act

Skills:· Persistence, tact and patience dealing with difficult people· Ability to speak with physicians, other health workers, and insurance companies on clinical matters.· Maintenance of detailed records

• Routine medical billing practice
• Information  gathering and data input
• Soliciting  sensitive information from patients and other financially responsible  parties
• Cooperating with the physicians, insurers, and other coworkers
• Remaining calm with patients and other financially responsible parties under stressful conditions

Abilities:

• Communicate on a professional level in both written and verbal formats 
• Perform multiple tasks in a timely manner
• Maintain regular and predictable attendance 
• Perform efficiently in a high-pressure setting
• Deal effectively and professionally with various personalities on a routine basis
• Develop and maintain professional relationships with coworkers
• Identify and  solve routine problems encountered in the Utilization Review department
• Collect data at a level sufficient to meet Utilization Review department mandated needs
• Meet deadlines and remain on timelines
• Explain basic billing activities so patients and other financially responsible parties can understand the issues related to their medical billing

Salary : $17 - $27