Authorization Specialists

Essential Functions

• Monitor the authorizations of upcoming cases on physician’s calendars ensuring authorization for office visits is obtained in a timely and accurate manner.
• Document authorizations and progress of authorizations in the patient's chart. Enter information within case management.
• Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing working relationships with both internal and external customers.
• Work with the department manager to respond to and reduce complaints timely and professionally.
• Ensure strict confidentiality of all health records, member information and meet HIPPA guidelines.

Required Skills/ Abilities

• Effective in organization and billing requirements and authorization process
• Medical terminology.
• Skill in using computer programs and applications including Microsoft/ Excel, Microsoft Word and Outlook.
• Knowledge of insurance plans and procedures.
• Adherence to all policies and procedures, including standards for safety, attendance, punctuality, and personal appearance.
• Must be able to establish and maintain effective working relationships with management and peers.
• Ability to multitask in a fast-paced environment. Must be detailed oriented with strong organizational skills.
• Ability to work independently and demonstrate the ability to analyze data

Physical and Mental Demands

·         Prolonged periods of sitting at a desk and working on a computer.

• Manual dexterity using a calculator, keyboard, photocopier, and other office equipment.
• Lifting of up to 15 pounds unassisted. Frequent bending, reaching, and repetitive hand movements standing, walking, squatting and sitting.
• Ability to view computer screens for long periods of time.

Duties/ Responsibilities

• Contact the insurance company to see if authorization is needed for injections, images, in-office procedures, and visits.
• Obtain and document the authorization and benefit details and attach the information to claim for said dates of service.
• Work with Medical Assistants and advise them of the status of authorization.
• Maintain copies of the requests and the results by reference number and proof documents.
• Perform related work as required and other projects and duties as assigned.
• Assist in the insurance verification process as well as requesting referral authorization.
• Contact patients to obtain accurate insurance information.
• Participate in educational activities and attend monthly staff meetings.
• Maintain real-time authorization chats via Athena and Outlook.
• Responsible for medication sign out, order requests, and claim review.
• Orders, receives, and maintain inventory of drugs and ensures their security within the facility.
• Restock, label, collect, dispense and maintain inventory/ submission requests for medications.
• Keeping track of follow ups and schedule patients accordingly.
• Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue.