What are the responsibilities and job description for the Authorization Specialist position at WMC Health?
Job Details : Job Summary :
The Authorization Specialist is responsible for performing complex clerical procedures related to verifying insurance information and obtaining authorization for inpatient admissions and specialized clinical procedures and treatments in accordance with established rules, procedures, specified time frames, and regulatory requirements. The Specialist processes clinical information in a timely manner to prevent treatment delays and to avoid denials from third party payers and maintains confidentiality of patient information.
Responsibilities :
- Enters and retrieves information from various automated systems and prepares specializedreports.
- Perform telephonic clinical reviews to Behavioral Health Managed Care Organizations in order to obtain ongoing authorization.
- Ensure completion of Medicare Physician Certification according to regulatory timeline.
- Collects demographic and insurance data and enters accurately into specialized automatedsystems.
- Prepares, reviews for completion, and maintains required documents in accordance withestablished procedures, time frames and regulatory requirements.
- Makes contact to obtain missing information for incomplete forms.
- Advises patients and clinical staff of problems with insurance authorizations and resubmitsrequests with additional or revised information.
- Contacts insurance providers to confirm level of benefits for inpatient admissions.
- Responds to customer inquiries and provides information.
- Serves as liaison between the physician's offices, patients, case management department andPatient Registration.
- Follows up with patients, physicians, clinical and ancillary departments to ensure optimumdelivery of services.
- Communicates with case managers, hospital personnel, and external agencies to provideinformation or resolve discrepancies.
Qualifications / Requirements :
Experience :
Two to three years of clerical experience in health care field or related area required, with preference to behavioral health experience.
Education :
A high school diploma or equivalency required, Associates Degree Preferred
Licenses / Certifications :
N / A
About Us :
NorthEast Provider Solutions Inc.
Benefits :
We offer a comprehensive compensation and benefits package that includes :
