Authorization Denials Specialist - Full Time

In this role you will be:

• Utilizing an understanding of medical insurance and the clinical policies that determine the authorization protocols for each health plan.
• Identifying all appointments and procedures for assigned departments that require authorization by monitoring the schedules, system reports, and dashboards.
• Identifying the referral and authorization requirements of the patients; insurance plans by using various online resources according to department workflows.
• Demonstrating knowledge of insurance carrier guidelines, clinical policies, and state guidelines pertaining to referrals and prior authorization.
• Verifying insurance eligibility and benefits and updating the patient’s insurance information as necessary.
• Completing referrals and prior authorizations in a timely manner according to department guidelines and workflows.
• Communicating clearly and effectively with patients, physicians, office staff, and managers to resolve issues that may result in a denied or delayed authorization request.
• Demonstrating the ability to request, prepare, and recognize the documentation required to support the medical necessity for the service being authorized.
• Providing the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service.
• Ensuring that appropriate and accurate information is entered in the patient account.
• Responding timely and collaborating effectively with the reimbursement department teams to limit denials and ensure proper reimbursement.
• Collaborating with team members to meet department deadlines and benchmarks.

QUALIFICATIONS

Required:

• EDUCATION: High school diploma, medical terminology, vocational/technical school diploma preferred
• EXPERIENCE:
  • 2-4 years related clinical experience preferred
  • Experience with standard office equipment and machines required
  • Microsoft Office Suite experience required
• LICENSURE/CERTIFICATION: N/A