What are the responsibilities and job description for the Authorization Specialist position at Conway Medical Center?
Position Summary:
The Authorization Specialist (AS) is assigned patients to obtain insurance to determine if an authorization is required for the testing/procedure being ordered by the requesting physician/practitioner. The Authorization Specialist AS will check patient demographics and more importantly insurance information to ensure Conway Medical Center has the most up-to-date information for accurate reimbursement submission.
Qualifications
Education:
- High School Diploma required.
Experience:
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Two (2) years’ experience in hospital and/or physician billing/pre-authorization or insurance verification.
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Demonstrated knowledge of health insurance plans including: Medicare; Medicaid, HMO’s; and PPO’s required.
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Familiarity with electronic health records (E.H.R.) and documentation requirements and accessibility.
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Knowledge of online insurance eligibility and insurance verification systems.
Licensure/Certification/Registration:
- Medical Terminology certification preferred.
- Certification or Associate degree in ICD-10-CM/ICD-10-PCS; CPT, HCPCS preferred
- Certified Health Access Associate credential preferred
Duties & Responsibilities:
- Collaborates with designated clinical contacts that require escalation to peer-to-peer review.
- Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals.
- Educate and counsel patients on their insurance coverage and explain payment options that are available to them.
- Work with front line staff to ensure collections are secured at time of presentation.
- Always displays exemplary core customer service skills.
- Consistently display effective verbal and written communication skills.
- Proficient understanding and use of technology/PC skills required.
- Work well in a fast-paced environment; efficiently organize work and maintain a high level of accuracy and productivity.
- Completes other duties as assigned by department leadership.
