Pre-Authorization Specialist

Job Title Pre-Authorization Specialist

Reports To

The Pre-Authorization Specialist position will report directly to the Revenue Cycle Manager.

Position Summary

The Pre-Authorization Specialist will be responsible for obtaining authorization from insurance companies and other third-party payers to ensure timely reimbursement for medical services provided. This role requires effective communication skills, attention to detail, and the ability to navigate insurance authorization processes efficiently.

Responsibilities and Duties:

Obtains Authorizations

• Initiates the authorization process with insurance companies by submitting all required documentation and information.
• Follow ups with insurance companies to obtain timely approval for medical services.

Specific Duties by Medical Specialty

• Ophthalmology: Pre-authorization and verification for surgery at surgery center, collection of all pre-payments for specialty lenses, creating charge and posting payments for specialty lenses. Processing of referrals if needed.

• Surgery: Scheduling and pre-authorization for hospital and out-patient surgery procedures and in-office procedures to include processing of referrals if needed.
• Cardiology: Pre-authorization and verification for testing only. Nuclear studies, stress tests, echo studies, ABPM and holters monitor to include referrals if needed.
• Radiology: Pre-authorization and verification for facility procedures only and to include referrals if needed.

Verifies Insurance Coverage

• Reviews patient insurance details and benefits to determine coverage for specific medical services.
• Communicates with patients and insurance companies to clarify coverage details when necessary.

Documentation and Records

• Maintains accurate and updated records of all authorization requests and communications.
• Documents all relevant information regarding insurance coverage, authorizations, denials, and any additional requirements from payers.
• Documents all authorization notes in the EHR and scan in all documentation from the payer or 3^rd party approval authority.

Collaborates with Providers

• Collaborates closely with healthcare providers, including physicians, nurses, and administrative staff, to gather necessary medical documentation and ensure appropriate codes and information are included in authorization requests.

Insurance Appeals

• Assists in the insurance appeals process for denied authorizations.
• Gathers additional information, follow up with insurance companies, and provide necessary documentation to support the appeal.

Communications and Customer Service

• Maintains effective communication with patients and insurance companies, to resolve any issues or discrepancies related to authorizations.
• Provides timely and knowledgeable responses to inquiries and concerns.

Performs other job-related duties as assigned.

• Attends meetings as required.
• Adheres to HIPAA guidelines/regulations/annual HIPAA training and other required training.

Education

• High school diploma or equivalent required; associate or bachelor's degree in healthcare administration or related field preferred.

Work Experience

• 2 years of experience in medical billing, insurance authorization, or related field.

Knowledge

• Maintain knowledge of medical terminology
• Insurance and billing knowledge
• Knowledge of the medical authorization process

Skills/Abilities

• Excellent written and verbal communication skills, with the ability to effectively communicate complex information to patients, insurance companies, healthcare providers, and in face-to-face situations with patients.
• Proficient in using electronic health records for data entry, record-keeping, and communication. Preference given to eCW (eClinical Works).
• Detail-oriented with a strong ability to prioritize tasks and manage multiple authorizations simultaneously.
• Knowledge of insurance billing and coding systems (ICD-10, CPT, HCPCS) is a plus.
• Ability to work independently as well as collaboratively in a team-oriented environment.
• Professional communication skills

Physical Requirements

• The work is sedentary. Typically, the employee may sit comfortably to do the work. However, there may be some walking, standing, bending, carrying of light items, driving an automobile, etc. No special physical demands are required to perform the work.

Interpersonal Skills

• Courtesy, tact, and diplomacy are essential elements of the job. Work involves much personal contact with others inside and/or outside the organization for purposes of giving or obtaining information, building relationships, or soliciting cooperation.

Work Environment

• Environmentally controlled medical office environment: Work hours subject to office needs to ensure coverage during all hours of operation.

Benefits: Benefits Eligible

• For more information on UCF Health benefits including cost go to: https://ucfhealth.com/careers/