Medical Authorization and Referral Specialist

Job Description

The Medical Office Insurance Authorization Specialist is responsible for the overall success of the chart preparation and insurance authorization procurement function. This individual provides good judgement in the coordination of all practice activities that contribute to assuring that the charts are prepared and that all authorizations for treatment have been received prior to the patient appointment. This position requires knowledge of medical billing, insurance verification and insurance authorization processes. Knowledge of basic policies and procedures or functions of a multi-physician practice. Knowledge of HIPAA, Compliance, and OSHA regulations related to an outpatient practice. Knowledge of EMR and other clinic computer programs and applications. Requires skill in exercising a high degree of initiative, judgement, discretion, and decision-making to optimally achieve the goals of the position. Skill in establishing and maintaining effective working relationships with co-workers, physicians, leadership staff, patients, and the public. Ability to have knowledge of, organize and prioritize work effectively to meet the set goals, deadlines and objectives of the position. This includes acquiring and documenting accurate patient information, and meeting patient appointment readiness goals. Ability to communicate clearly and effectively both in writing and verbally

1.1 Begin accurately working on pulled patient appointment charts 3 days in advance, if possible, to complete the following task in a timely manner:

A. For patients who have only EMR charts: Print off last EMR note and place in folder.

B. For patients who are in the EMR system and also have a paper chart: Print off last EMR note and include in paper chart.

C. For patients who only have paper charts and are not yet in the EMR system: Include the paper chart and print out the Financial Demand Inquiry from the old MYSIS/Allscripts system.

1.2 Assure that the Verification List is obtained at least 3 days in advance from the Verification Specialist and assure that all visits and procedures have been verified prior to the patient visit.

1.3 Begin authorization process at least 3 days in advance prior to patient visit, when possible.

1.4 Accurately obtain visit and procedure authorizations through patient primary care physicians or patient insurance payers.

1.5 Assure that authorization numbers are documented, and that primary care physician fax sheets are scanned into the EMR, as well as documented in Practice Plus and on the encounter form.

1.6 For authorizations obtained through the patient’s insurance carrier, assure that the authorization numbers are documented and attached to the appointment in Practice Plus, as well as documented on the encounter form.

1.7 Assure that the number of visits or treatments authorized are clearly documented in Allscripts and on the encounter form. Indicate the number of approved visits or treatments that are left from the original authorization is also documented.

1.8 Assure that injection authorizations are obtained and up-to-date, as well as documented in Practice Plus and on the encounter form.

1.9 Assure that the file cases are packed and completed each day and ready to go to the practices.

1.10 Accurately processes authorizations for add on patients from all offices.

1.11 Highlights balances and assures that accurate co-pays and deductibles due are indicated on encounter forms.

1.12 Double checks to ensure all demographic information on the encounter is accurate (i.e. name spelling, referring doctor, etc.)

1.13 Utilizes patient chart on an as needed basis, accessing only information related to treatment, payment, and health operations.

1.14 Maintains and adheres to the company’s HIPAA, Compliance, and OSHA regulations.

1.15Other duties as assigned.

Job Type: Full-time

Excellent benefits package provided including Medical, Dental, Vision, LTD, STD, 401k matching, uniform allowance.

This is not a remote position.
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Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Work Location: In person