What are the responsibilities and job description for the Authorization Specialist position at PT Solutions?
The purpose of the Authorization Specialist position is to be responsible for all aspects of the prior authorization process. Responsibilities include collecting all the necessary documentation, contacting the client for additional information and completion of authorization (both private clinic and hospital clinics). Complete, timely, and accurate identification and submission of prior and retro authorization requests to the payors. Interacts with clients, insurance companies, patients, and sales representatives, as necessary, to request for prior authorizations. Responsible for documenting account activity, updating patient and claim information within assigned EMR system. Ensure all functionalities are utilized for the most efficient processing of claims and identifies prior authorization trends and / or issues resulting in delayed claims processing. Provides the highest level of customer service to internal and external clients. This position requires simple computer data entry and use of Microsoft Office Products
ESSENTIAL FUNCTIONS
- Obtains necessary information to submit authorizations for new and continue of care patient needs.
- Communicates and works effectively with colleagues from other departments
- Become proficient in the use of ICD-10 and CPT codes
- Understand Payor expectations for billing, reimbursement, credentialing, audit
- Identify and report trends and prior authorization issues relating to billing and reimbursement
- Reviews accounts daily while meeting or exceeding all daily, weekly, and monthly production goals
- Document all account activity and correspond to inquires in a timely manner
- Proactively manages and maintains all outstanding authorization accounts to increase billing of clean claims
- Research patient accounts due to invalid and / or missing authorization information and correspond with clients,
- insurance companies, patients, sales representatives to obtain the necessary information to ensure accurate, timely
- and complete claims submission
- Prepares daily productivity report and submits it to Authorization Supervisor
- Performs additional duties deemed necessary to the position and its function
DESIRED SKILLS & ABILITIES
