What are the responsibilities and job description for the Procedure Authorization Specialist position at Resolve Pain Solutions?
We are seeking a detail-oriented and organized Authorization Specialist to join our team. In this role, you will be responsible for reviewing medical records, verifying insurance benefits, and obtaining authorizations for procedures. You will work closely with the billing staff, procedure coordinators, and surgery centers to ensure smooth coordination of services and timely authorizations. The ideal candidate will have strong communication skills, the ability to handle multiple tasks efficiently, and at least 1-3 years of experience in an insurance authorization setting. This position requires a high school diploma, with additional experience in customer service or healthcare insurance preferred. This is a non-licensed, clerical role reporting directly to the Director of Billing.
Primary Job Functions:
Most Demanding Tasks:
High school diploma or GED
Experience:
Primary Job Functions:
- Review patient insurance benefits for coverage of procedure ordered.
- Obtain necessary authorization for all in clinic services, all procedures done outside of clinic.
- Appeals medical necessity denials
- Schedule Provider Peer to Peers when necessary
- Works with Billing staff on authorization issues
- Communicates with Procedure Scheduling Co-Ordinator and Surgery Centers on authorization status of all procedures.
- Participates in educational activities and attends monthly staff meetings.
- Conducts self in accordance with privacy practices.
- Maintains strictest confidentiality; adheres to all HIPAA regulations.
Most Demanding Tasks:
- Verifying and reporting very accurate insurance information
- Maintain up to date information on various insurance companies and any relevant changes
- Communicating important insurance data to appropriate staff
- Cope with varying and unpredictable situations
- Communicating important patient financial changers to appropriate staff
High school diploma or GED
Experience:
- Minimum of 1 – 3 years in an insurance authorization setting
- Successful customer service and healthcare/insurance experience 1-2 years
- Experience in office/clerical environment 1-2 years
- Computer and Excel experience 1-2 years
- Strong computer/keyboarding skills
- Type 25 wpm
- 10 key proficient
- Strong organizational skills and ability to multi-task
- Ability to deal with stress and high demands
- Have excellent written, oral, and telephone communication skills.
- Demonstrate high standards of quality and accuracy.
- Have strong follow-through on tasks and assignments.
